Provider Demographics
NPI:1083260186
Name:REDFERN, JESSICA GRACE (MAOM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:GRACE
Last Name:REDFERN
Suffix:
Gender:F
Credentials:MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 BOTOLPH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1909
Mailing Address - Country:US
Mailing Address - Phone:857-488-0807
Mailing Address - Fax:
Practice Address - Street 1:83 BOTOLPH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-1909
Practice Address - Country:US
Practice Address - Phone:857-488-0807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist