MEDICARE: JACKELINE BARBOSA RN

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	163W00000X	Registered Nurse	RN2307044	MA

General Provider Information

NPI Number	:	1578926226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKELINE BARBOSA RN

Provider Business Mailing Address
First Line	:	500 COLUMBIA RD
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02125-2322
Country	:	US
Telephone Number	:	617-287-8000
Fax Number	:	617-740-8070

Provider Business Practice Location Address
First Line	:	500 COLUMBIA RD
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02125-2322
Country	:	US
Telephone Number	:	617-287-8000
Fax Number	:	617-740-8070

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

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	05/09/2016

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