Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 284747 | MA |
NPI | 1003248683 |
---|---|
Provider Name | Rebecca A Souza |
First Address | Bridgewater, MA 02324-3117 |
Second Address | Bridgewater, MA 02324-3117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2013 |
Last Update Date | 27/04/2020 |