Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN251201 | MA |
NPI | 1730639253 |
---|---|
Provider Name | Ms. Erin Ivatts |
First Address | Walpole, MA 02081-1837 |
Second Address | Walpole, MA 02081-1837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2016 |
Last Update Date | 27/01/2022 |