Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN202587 | MA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 202587 | MA |
NPI | 1396067401 |
---|---|
Provider Name | Ms. Christina M. Defusco |
First Address | Boston, MA 02118-2371 |
Second Address | Boston, MA 02118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2010 |
Last Update Date | 16/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110085493A | (05) | MA |