MEDICARE: JILL A FIELEKE NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	228571NP	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN0287	OTHER		MEDICARE ID

General Provider Information

NPI Number	:	1871663989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL A FIELEKE NP

Provider Business Mailing Address
First Line	:	3 FAIR OAKS AVE
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02460-1216
Country	:	US
Telephone Number	:	857-205-0441
Fax Number	:

Provider Business Practice Location Address
First Line	:	173 MOUNT AUBURN ST
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-4005
Country	:	US
Telephone Number	:	617-903-5900
Fax Number	:	618-618-6028

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	01/23/2019

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