Healthcare Provider Details

I. General information

NPI: 1275197337
Provider Name (Legal Business Name): JAMIE ANASTASIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 1ST AVE
CHARLESTOWN MA
02129-3109
US

IV. Provider business mailing address

133 OLD ROAD TO NAC COR CREDENTIALING DEPARTMENT SUITE 320
CONCORD MA
01742-4169
US

V. Phone/Fax

Practice location:
  • Phone: 617-952-5000
  • Fax:
Mailing address:
  • Phone: 617-952-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2308066
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: