Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 159929 | MA |
NPI | 1043286172 |
---|---|
Provider Name | Mrs. Catherine O'keeffe |
First Address | Yarmouth Port, MA 02675-2000 |
Second Address | Yarmouth Port, MA 02675-2000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 23/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0357243 | (05) | MA |
NP0573 | BCBS (01) | MA |
P00098249 | RAILROAD MEDICARE (01) | MA |
R95761 | (02) | MA |