Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN2319438 | MA |
NPI | 1013499342 |
---|---|
Provider Name | Jacqueline Truex-Greenslet |
First Address | North Adams, MA 01247-3942 |
Second Address | North Adams, MA 01247-3942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2018 |
Last Update Date | 04/09/2018 |