Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 123532 | MA |
NPI | 1356544241 |
---|---|
Provider Name | Mary Ann Bray |
First Address | Needham, MA 02492-3029 |
Second Address | Boston, MA 02210-1114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 08/07/2007 |