Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 257436 | MA |
NPI | 1063838043 |
---|---|
Provider Name | Rachel Bereiweriso |
First Address | Lynn, MA 01905-1626 |
Second Address | West Roxbury, MA 02132-4927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2014 |
Last Update Date | 13/03/2014 |