Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN2274692 | MA |
NPI | 1043568827 |
---|---|
Provider Name | Mrs. Kacie Kiyoko Nakamura Gaudet |
First Address | Chestnut Hill, MA 02467-3181 |
Second Address | Plymouth, MA 02360-4873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2012 |
Last Update Date | 27/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20121631 | PEDIATRIC NURSING CERTIFICATION BOARD (01) |