Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 5653 | CT |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 230107 | MA |
NPI | 1043270622 |
---|---|
Provider Name | Michelle Stumm |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01605-2903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110013861A | (05) | MA |
321320 | (05) | MA |