Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN2296604 | MA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN2296604 | MA |
NPI | 1376094706 |
---|---|
Provider Name | Victoria Creedon |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2016 |
Last Update Date | 21/10/2016 |