Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 167734 | MA |
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN167734 | MA |
NPI | 1013598291 |
---|---|
Provider Name | Raynee Bird |
First Address | Springfield, MA 01199-1000 |
Second Address | Springfield, MA 01107-1619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2021 |
Last Update Date | 22/07/2021 |