Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN2276512 | MA |
NPI | 1033860929 |
---|---|
Provider Name | Roxanne Trevarthan |
First Address | Worcester, MA 01603-2012 |
Second Address | Worcester, MA 01603-2012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2022 |
Last Update Date | 12/01/2022 |