Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 236146 | MA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 236146 | MA |
NPI | 1013045517 |
---|---|
Provider Name | Ms. Kathleen Victoria Fitch |
First Address | Boston, MA 02114-2621 |
Second Address | Boston, MA 02114-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 26/04/2017 |