Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 309667 | NY |
N | 363L00000X | Nurse Practitioner | RN2313980 | MA |
NPI | 1053819326 |
---|---|
Provider Name | Stephanie Duverge |
First Address | Randolph, MA 02368-4926 |
Second Address | Randolph, MA 02368-4926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2018 |
Last Update Date | 26/07/2021 |