Provider Demographics
NPI:1114397593
Name:SEQUIN, JONATHAN
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SEQUIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 GLENSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:MA
Mailing Address - Zip Code:01504-1549
Mailing Address - Country:US
Mailing Address - Phone:774-266-3479
Mailing Address - Fax:
Practice Address - Street 1:41 GLENSIDE DR
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:MA
Practice Address - Zip Code:01504-1549
Practice Address - Country:US
Practice Address - Phone:774-266-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2298644163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse