Healthcare Provider Details

I. General information

NPI: 1194863233
Provider Name (Legal Business Name): GAIL JACQUET CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WASHINGTON ST
NEWTON MA
02462-1650
US

IV. Provider business mailing address

2000 WASHINGTON ST
NEWTON MA
02462-1650
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6378
  • Fax: 617-243-6377
Mailing address:
  • Phone: 617-243-6378
  • Fax: 617-243-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number168968
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: