Healthcare Provider Details

I. General information

NPI: 1588258313
Provider Name (Legal Business Name): JAMILYNN S NOVO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S MAIN ST STE 203
THOMASTON CT
06787-1741
US

IV. Provider business mailing address

PO BOX 3099
WAREHAM MA
02571-3099
US

V. Phone/Fax

Practice location:
  • Phone: 860-880-8202
  • Fax:
Mailing address:
  • Phone: 508-574-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number146858
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: