Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN2264485 | MA |
NPI | 1003282286 |
---|---|
Provider Name | Rebecca Match |
First Address | Brockton, MA 02301-7122 |
Second Address | Brockton, MA 02301-7122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2015 |
Last Update Date | 04/01/2017 |