Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN156037 | MA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 156037 | MA |
NPI | 1194786368 |
---|---|
Provider Name | Paula Anne Beaver |
First Address | Springfield, MA 01199-1001 |
Second Address | Springfield, MA 01107-1619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
321192 | (05) | MA |