Provider Demographics
NPI:1154704575
Name:PETZY, JAYNE M (RN)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:M
Last Name:PETZY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7517
Mailing Address - Country:US
Mailing Address - Phone:508-395-9774
Mailing Address - Fax:
Practice Address - Street 1:32 QUINCY ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-7517
Practice Address - Country:US
Practice Address - Phone:508-395-9774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155407163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse