Healthcare Provider Details

I. General information

NPI: 1033935697
Provider Name (Legal Business Name): DANIELLE MARIE JUSSEAUME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2024
Last Update Date: 11/28/2024
Certification Date: 11/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND AVE
SALEM MA
01970-2714
US

IV. Provider business mailing address

10 PRESCOTT ST APT 3
SALEM MA
01970-3014
US

V. Phone/Fax

Practice location:
  • Phone: 978-354-1200
  • Fax:
Mailing address:
  • Phone: 508-612-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number2355007
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: