Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN2266782 | MA |
N | 363LA2100X | Nurse Practitioner - Acute Care | RN2266782 | MA |
NPI | 1013313618 |
---|---|
Provider Name | Poliana Larissa Lin |
First Address | Boston, MA 02241-5348 |
Second Address | Leominster, MA 01453-2253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2014 |
Last Update Date | 04/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110103877A | (05) | MA |