Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 2283838 | MA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2283838 | MA |
NPI | 1003299090 |
---|---|
Provider Name | Ms. Kristina Marie Anderson |
First Address | Boston, MA 02119-3791 |
Second Address | Boston, MA 02118-3549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2015 |
Last Update Date | 21/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110105978A | (05) | MA |