Healthcare Provider Details

I. General information

NPI: 1750014254
Provider Name (Legal Business Name): JEANNE ADRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2022
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVAN ST STE 102
DANVERS MA
01923-2763
US

IV. Provider business mailing address

75 SYLVAN ST STE 102
DANVERS MA
01923-2763
US

V. Phone/Fax

Practice location:
  • Phone: 978-774-7566
  • Fax: 978-774-4389
Mailing address:
  • Phone: 978-774-7566
  • Fax: 978-774-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2278171
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: