Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TH0100X | Health Service |
NPI | 1396244760 |
---|---|
Provider Name | Samantha O'brien |
First Address | Danvers, MA 01923-1409 |
Second Address | Danvers, MA 01923-1409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2018 |
Last Update Date | 12/02/2018 |