Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 712733 | MA |
NPI | 1023218112 |
---|---|
Provider Name | Sandra Ventura |
First Address | Westwood, MA 02090-1628 |
Second Address | Westwood, MA 02090-1628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 18/07/2007 |