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General NPI Number Information
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NPI Number | 1609202340
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Entity Type | Individual
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Provider Name | SHIRLINE JEAN MSN, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 1250 HANCOCK ST
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City | QUINCY
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State | MA
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Zip | 02169-4339
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Country | US
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Telephone | 176-774-0920
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 HANCOCK ST
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City | QUINCY
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State | MA
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Zip | 02169-4339
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Country | US
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Telephone | 176-774-0920
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2264841
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | RN2264841
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License Number State | MA
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