Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 2277692 | MA |
NPI | 1013359900 |
---|---|
Provider Name | Susan Jensen |
First Address | Westford, MA 01886-3115 |
Second Address | Groton, MA 01450-1879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2013 |
Last Update Date | 22/07/2013 |