Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 205358 | MA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 205358 | MA |
NPI | 1033227186 |
---|---|
Provider Name | Susan Clarkson Mcginnis |
First Address | Charlestown, MA 02129-1719 |
Second Address | West Roxbury, MA 02132-4927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 02/08/2012 |