Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 252393 | MA |
NPI | 1023072246 |
---|---|
Provider Name | Mr. Sterling Bouxman |
First Address | Stoughton, MA 02072-3842 |
Second Address | Randolph, MA 02368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 26/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0799092 | (05) | MA |
Q46015 | (02) | MA |