Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN2274551 | MA |
NPI | 1336610062 |
---|---|
Provider Name | Natalia Sullivan Vragovic |
First Address | Londonderry, NH 03053-2389 |
Second Address | Boston, MA 02215-5491 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2018 |
Last Update Date | 06/12/2018 |