Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN251609 | MA |
NPI | 1003488057 |
---|---|
Provider Name | Suzanne Maria Ohara |
First Address | Tewksbury, MA 01876-3025 |
Second Address | Tewksbury, MA 01876-3025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2021 |
Last Update Date | 10/07/2021 |