Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 125.068584 | IL |
N | 208000000X | Pediatrician | 282607 | MA |
NPI | 1003264458 |
---|---|
Provider Name | Miki Nishitani |
First Address | Boston, MA 02215-5418 |
Second Address | Boston, MA 02215-5418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2016 |
Last Update Date | 09/06/2020 |