Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 236502 | MA |
NPI | 1053640607 |
---|---|
Provider Name | Mrs. Tina Marie Gebarowski |
First Address | Milford, MA 01757-1252 |
Second Address | Milford, MA 01757-1252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2009 |
Last Update Date | 10/12/2009 |