Healthcare Provider Details

I. General information

NPI: 1063844439
Provider Name (Legal Business Name): JESSICA BROOKE HANCOCK-ALLEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 WASHINGTON ST
BOSTON MA
02108-4634
US

IV. Provider business mailing address

294 WASHINGTON ST
BOSTON MA
02108-4634
US

V. Phone/Fax

Practice location:
  • Phone: 617-728-6000
  • Fax:
Mailing address:
  • Phone: 617-728-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2262804
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: