MEDICARE: MRS. JESSICA M MCNALLY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN2316412	MA

General Provider Information

NPI Number	:	1154916120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA M MCNALLY FNP

Provider Business Mailing Address
First Line	:	12 CHRISTOPHER ST
Second Line	:
City	:	NEWBURYPORT
State	:	MA
Zip	:	01950-1910
Country	:	US
Telephone Number	:	215-630-5944
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 MARSTON ST APT 202
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01841-2357
Country	:	US
Telephone Number	:	978-946-8550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/18/2021

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