Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | NP9917 | MA |
NPI | 1033107396 |
---|---|
Provider Name | Lynne Monfreda |
First Address | Leominster, MA 01453-2253 |
Second Address | Leominster, MA 01453-2253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 06/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP9917 | STATE LICENSE (01) | MA |