MEDICARE: MS. JANEL KRISTI TAN B.A.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1790886661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANEL KRISTI TAN B.A.

Provider Business Mailing Address
First Line	:	146 COMMONWEALTH AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02116-2901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 HANCOCK CT
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-5210
Country	:	US
Telephone Number	:	617-847-1950
Fax Number	:

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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