| NPI | 1043015837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN SLABAUGH Nurse Practitioner 617-517-6340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-02-15 |
| Last Update Date | 2025-02-19 |