=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194265488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANNINE ANN HUGHES CNMT.,RTR.,RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2017
-----------------------------------------------------
Last Update Date | 03/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 DETTLING RD
-----------------------------------------------------
City | MAYNARD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01754-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-793-9137
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13 DETTLING RD
-----------------------------------------------------
City | MAYNARD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01754-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 253977
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 247100000X
-----------------------------------------------------
Taxonomy Name | Radiologic Technologist
-----------------------------------------------------
License Number | 189404
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2471N0900X
-----------------------------------------------------
Taxonomy Name | Nuclear Medicine Technology Radiologic Technologist
-----------------------------------------------------
License Number | 02398
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2471N0900X
-----------------------------------------------------
Taxonomy Name | Nuclear Medicine Technology Radiologic Technologist
-----------------------------------------------------
License Number | 009140
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------