Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN271965 | MA |
NPI | 1003215633 |
---|---|
Provider Name | Melissa K Botelho |
First Address | Dartmouth, MA 02747-1242 |
Second Address | Dartmouth, MA 02747-1242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2014 |
Last Update Date | 12/02/2018 |