Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN2277952 | MA |
NPI | 1023524170 |
---|---|
Provider Name | Mr. Robert Normandin |
First Address | Burlington, MA 01803-3700 |
Second Address | Needham, MA 02494-3133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2017 |
Last Update Date | 26/12/2017 |