Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 254003 | MA |
NPI | 1033386156 |
---|---|
Provider Name | Marketa Rejtar |
First Address | Stoneham, MA 02180-2263 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2008 |
Last Update Date | 27/04/2015 |