Healthcare Provider Details

I. General information

NPI: 1346726767
Provider Name (Legal Business Name): JESSENIA FALOM CABRAL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 VETERANS DRIVE
WHITE RIVER JUNCTION VT
05009-0001
US

IV. Provider business mailing address

39 E SILVER ST APT 5
WESTFIELD MA
01085-4479
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-9363
  • Fax:
Mailing address:
  • Phone: 781-879-7945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2325453
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: