Provider Demographics
NPI:1518141787
Name:HOTALING, GWEN (NP)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:HOTALING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-6099
Mailing Address - Country:US
Mailing Address - Phone:508-650-7730
Mailing Address - Fax:508-650-7818
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-6099
Practice Address - Country:US
Practice Address - Phone:508-650-7730
Practice Address - Fax:508-650-7818
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160193363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health