Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN2331932 | MA |
NPI | 1003446311 |
---|---|
Provider Name | Theresa Bui |
First Address | Medford, MA 02155-4530 |
Second Address | Medford, MA 02155-4530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2020 |
Last Update Date | 26/01/2020 |