Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | RN231353 | MA |
NPI | 1326442203 |
---|---|
Provider Name | Mrs. Laurie Jean Basinait |
First Address | Great Barrington, MA 01230-1713 |
Second Address | Great Barrington, MA 01230-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2014 |
Last Update Date | 26/11/2018 |