Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 262962 | MA |
NPI | 1013002799 |
---|---|
Provider Name | Walter J Zawacki |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01605-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 01/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110073126A | (05) | MA |