Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 75153 | MA |
N | 111NI0900X | Internist | 75153 | MA |
N | 207RR0500X | Rheumatology | 75153 | MA |
NPI | 1023198405 |
---|---|
Provider Name | Sandra V Kristiansen |
First Address | Westborough, MA 01581-3643 |
Second Address | Westboro, MA 01581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 21/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E19216 | (02) |