Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 260488 | MA |
NPI | 1083869192 |
---|---|
Provider Name | Mrs. Amy Beth Ditzel |
First Address | Weymouth, MA 02190-2432 |
Second Address | Weymouth, MA 02190-2432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2008 |
Last Update Date | 18/11/2008 |