Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN262019 | MA |
NPI | 1003124827 |
---|---|
Provider Name | Mr. Courtney Sullivan Fratto |
First Address | Watertown, MA 02472-3629 |
Second Address | Boston, MA 02115-5724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2010 |
Last Update Date | 14/09/2010 |