Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1003226713 |
---|---|
Provider Name | Kristy Shockley |
First Address | Lowell, MA 01854-1421 |
Second Address | Lowell, MA 01854-1421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2014 |
Last Update Date | 02/05/2014 |