=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346080611
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NADEGE JEAN CLAUDE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2024
-----------------------------------------------------
Last Update Date | 05/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1690A DORCHESTER AVE
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02122-1335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-991-4570
-----------------------------------------------------
Fax | 617-991-4570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 620
-----------------------------------------------------
City | MALDEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02148-0005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-991-4570
-----------------------------------------------------
Fax | 617-991-4570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number | CC310732
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------