Healthcare Provider Details

I. General information

NPI: 1740101203
Provider Name (Legal Business Name): YASMINE MERRIAM JAKIB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST
LYNN MA
01901-1314
US

IV. Provider business mailing address

4 HARVARD PL APT 3
CHARLESTOWN MA
02129-3775
US

V. Phone/Fax

Practice location:
  • Phone: 178-158-1390
  • Fax:
Mailing address:
  • Phone: 603-438-0292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2363740
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: