Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN253069 | MA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 05095723 | NH |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 253069 | MA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN253069 | MA |
NPI | 1003886540 |
---|---|
Provider Name | Steven B Gutwillig |
First Address | Leominster, MA 01453-5507 |
Second Address | Leominster, MA 01453-5507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 30/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30343142 | (05) | NH |
Q24621 | (02) |