Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN2299124 | MA |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN2299124 | MA |
NPI | 1063964245 |
---|---|
Provider Name | Mirian Torbado Barrientos |
First Address | Boston, MA 02119 |
Second Address | Boston, MA 02118-2309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2016 |
Last Update Date | 11/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110121514A | (05) | MA |