Healthcare Provider Details

I. General information

NPI: 1073794871
Provider Name (Legal Business Name): JEANNE MARIE HEROUX NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 PARK ST CAPE COD HOSPITAL/PSYCH CENTER
HYANNIS MA
02601-5230
US

IV. Provider business mailing address

27 PARK ST CAPE COD HOSPITAL/PSYCH CENTER
HYANNIS MA
02601-5230
US

V. Phone/Fax

Practice location:
  • Phone: 508-862-5566
  • Fax: 508-775-1598
Mailing address:
  • Phone: 508-862-5566
  • Fax: 508-775-1598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number214443
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: