Healthcare Provider Details

I. General information

NPI: 1912021296
Provider Name (Legal Business Name): JANE E CRONIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

275 MAIN ST
KINGSTON MA
02364-1910
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-9310
  • Fax:
Mailing address:
  • Phone: 781-585-3269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number203192
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: