Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 153467 | MA |
NPI | 1023099884 |
---|---|
Provider Name | Miss Judith H Haupt |
First Address | Turners Falls, MA 01376-1816 |
Second Address | Turners Falls, MA 01376-1816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 17/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9758038 | (05) | MA |
PI2257 | (02) | MA |