Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 199773 | MA |
NPI | 1003242900 |
---|---|
Provider Name | Tracey Ann Morgan |
First Address | Milton, MA 02186 |
Second Address | Milton, MA 02186 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2013 |
Last Update Date | 24/09/2013 |