Healthcare Provider Details

I. General information

NPI: 1083472021
Provider Name (Legal Business Name): JILLIAN ANN DEMPSEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

IV. Provider business mailing address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3112
  • Fax: 617-754-8791
Mailing address:
  • Phone: 617-667-3112
  • Fax: 617-754-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN10035648
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: