MEDICARE: JOANNA ALISE PHEASANT ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	RN2290734	MA

General Provider Information

NPI Number	:	1427470996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA ALISE PHEASANT ARNP

Provider Business Mailing Address
First Line	:	30 LOCUST ST
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-2052
Country	:	US
Telephone Number	:	413-582-2898
Fax Number	:	413-582-2958

Provider Business Practice Location Address
First Line	:	14 WILLIAMS ST
Second Line	:
City	:	WILLIAMSBURG
State	:	MA
Zip	:	01096-9427
Country	:	US
Telephone Number	:	413-268-3616
Fax Number	:	413-923-9311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	01/17/2014

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