Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 271479 | MA |
Y | 208600000X | Surgeon | 271479 | MA |
NPI | 1013359447 |
---|---|
Provider Name | Marlieke E Nussenbaum |
First Address | Boston, MA 02111-1552 |
Second Address | Boston, MA 02111-1552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2013 |
Last Update Date | 13/07/2017 |