Healthcare Provider Details

I. General information

NPI: 1245306448
Provider Name (Legal Business Name): SUSAN ANNE JAMIESON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 RESEARCH PL STE 310
NORTH CHELMSFORD MA
01863-2455
US

IV. Provider business mailing address

20 RESEARCH PL STE 310
NORTH CHELMSFORD MA
01863-2455
US

V. Phone/Fax

Practice location:
  • Phone: 617-782-7788
  • Fax: 617-783-5657
Mailing address:
  • Phone: 978-459-2152
  • Fax: 978-452-7285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN182212
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number182212
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: