Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN157542 | MA |
NPI | 1013292671 |
---|---|
Provider Name | Mrs. Elaine Ann Charbonnier |
First Address | Boston, MA 02130-3446 |
Second Address | Boston, MA 02130-3446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2011 |
Last Update Date | 14/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S38613 | (02) | MA |