Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN2290930 | MA |
NPI | 1003159609 |
---|---|
Provider Name | Ms. Laura Monroe Will |
First Address | Boston, MA 02118-2705 |
Second Address | Boston, MA 02118-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2013 |
Last Update Date | 05/05/2014 |