Healthcare Provider Details

I. General information

NPI: 1689500621
Provider Name (Legal Business Name): JACQUELINE NOEL CREGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 OLD TOWN WAY
HANOVER MA
02339-1526
US

IV. Provider business mailing address

336 OLD TOWN WAY
HANOVER MA
02339-1526
US

V. Phone/Fax

Practice location:
  • Phone: 781-771-8873
  • Fax:
Mailing address:
  • Phone: 781-771-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN2301119
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: