Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1992914709 |
---|---|
Provider Name | Jackie Clason |
First Address | Vineyard Haven, MA 02568-7903 |
Second Address | Vineyard Haven, MA 02568-7903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |