Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 141500 | MA |
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN141500 | MA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 141500 | MA |
NPI | 1013099795 |
---|---|
Provider Name | Joanne Jackson |
First Address | Springfield, MA 01199-1001 |
Second Address | Springfield, MA 01107-1112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 16/01/2019 |