Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN178349 | MA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 178349 | MA |
NPI | 1548630346 |
---|---|
Provider Name | Reasmey Chan Taing |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2015 |
Last Update Date | 09/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110105470A | (05) | MA |