Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 20051086 | MA |
NPI | 1033209218 |
---|---|
Provider Name | Ms. Stefanie A. Hall |
First Address | Boston, MA 02135 |
Second Address | Boston, MA 02135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/12/2008 |