Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN2316926 | MA |
NPI | 1013432186 |
---|---|
Provider Name | Ms. Katherine Elizabeth Oberwager |
First Address | Springfield, MA 01199-1001 |
Second Address | Holyoke, MA 01040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2017 |
Last Update Date | 15/08/2019 |