Healthcare Provider Details

I. General information

NPI: 1679025258
Provider Name (Legal Business Name): JESSICA DACIUS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 OBERY ST
PLYMOUTH MA
02360-2237
US

IV. Provider business mailing address

46 OBERY ST
PLYMOUTH MA
02360-2237
US

V. Phone/Fax

Practice location:
  • Phone: 508-830-6116
  • Fax:
Mailing address:
  • Phone: 508-830-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2299272
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2299272
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: