Healthcare Provider Details

I. General information

NPI: 1558737445
Provider Name (Legal Business Name): JOCELYN PEDRICK RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE FEGAN 11
BOSTON MA
02115-5724
US

IV. Provider business mailing address

117 PARK DR APT 37
BOSTON MA
02215-5100
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6388
  • Fax:
Mailing address:
  • Phone: 862-432-9824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2295287
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: