Healthcare Provider Details

I. General information

NPI: 1346080611
Provider Name (Legal Business Name): NADEGE JEAN CLAUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2024
Last Update Date: 05/25/2024
Certification Date: 05/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690A DORCHESTER AVE
BOSTON MA
02122-1335
US

IV. Provider business mailing address

PO BOX 620
MALDEN MA
02148-0005
US

V. Phone/Fax

Practice location:
  • Phone: 617-991-4570
  • Fax: 617-991-4570
Mailing address:
  • Phone: 617-991-4570
  • Fax: 617-991-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberCC310732
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: