Healthcare Provider Details

I. General information

NPI: 1699586495
Provider Name (Legal Business Name): JAIME HLIBOKI STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 COMMONWEALTH AVE
CHESTNUT HILL MA
02467-3858
US

IV. Provider business mailing address

140 COMMONWEALTH AVE
CHESTNUT HILL MA
02467-3800
US

V. Phone/Fax

Practice location:
  • Phone: 617-552-2756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2381664
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: