Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 154005 | MA |
NPI | 1073918876 |
---|---|
Provider Name | Regina Roberto |
First Address | Worcester, MA 01609-2247 |
Second Address | Worcester, MA 01609-2247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2014 |
Last Update Date | 23/10/2014 |