Healthcare Provider Details

I. General information

NPI: 1982685186
Provider Name (Legal Business Name): JANE W NDEGWA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON ST
BOXFORD MA
01921-1017
US

IV. Provider business mailing address

PO BOX 3904
PEABODY MA
01961-3904
US

V. Phone/Fax

Practice location:
  • Phone: 781-962-3060
  • Fax: 978-824-3872
Mailing address:
  • Phone: 781-883-2919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number235730
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: