Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN282743 | MA |
NPI | 1003326877 |
---|---|
Provider Name | Mrs. Valerie Ann Fitzgerald |
First Address | Boston, MA 02113-2424 |
Second Address | Boston, MA 02114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2017 |
Last Update Date | 06/10/2017 |