Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 206717 | MA |
NPI | 1083763908 |
---|---|
Provider Name | Yi Zhang |
First Address | Lexington, MA 02421-7519 |
Second Address | Waltham, MA 02451-1424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |