Healthcare Provider Details

I. General information

NPI: 1982045480
Provider Name (Legal Business Name): JESSIE BOISSY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 ROOT RD
WESTFIELD MA
01085-9832
US

IV. Provider business mailing address

209 ROOT RD
WESTFIELD MA
01085-9832
US

V. Phone/Fax

Practice location:
  • Phone: 413-568-3942
  • Fax:
Mailing address:
  • Phone: 413-568-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2260770
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: