Provider Demographics
NPI:1104108471
Name:RICHARDSON, JEANETTE M (NP)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:M
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:GENTILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:23 WARREN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:781-756-7273
Mailing Address - Fax:781-721-0725
Practice Address - Street 1:23 WARREN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-933-1198
Practice Address - Fax:781-729-7504
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2267910363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health