Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 123429 | MA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 123429 | MA |
NPI | 1033170360 |
---|---|
Provider Name | Linda Ann Raftery |
First Address | Boston, MA 02109-4806 |
Second Address | Wellesley, MA 02481-5420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0360210 | (05) | MA |
N402 | HARVARD PILGRIM (01) | MA |
NP1122 | BLUE CROSS (01) | MA |
S56269 | (02) | MA |