Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN2296060 | MA |
NPI | 1003278235 |
---|---|
Provider Name | Tanya White |
First Address | Bourne, MA 02532-3897 |
Second Address | Bourne, MA 02532-3897 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2016 |
Last Update Date | 25/02/2017 |