Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD16823 | RI |
NPI | 1083971097 |
---|---|
Provider Name | Mrs. Sara Washburn Fuller Geffert |
First Address | Providence, RI 02906-4923 |
Second Address | Providence, RI 02903-4923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2012 |
Last Update Date | 16/08/2019 |