Provider Demographics
NPI:1245219526
Name:STEELE, JERI J (LIC AC, DIPL OM,APRN)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:J
Last Name:STEELE
Suffix:
Gender:F
Credentials:LIC AC, DIPL OM,APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 CHARNOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-1110
Mailing Address - Country:US
Mailing Address - Phone:508-523-9729
Mailing Address - Fax:
Practice Address - Street 1:4 BARNES AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1202
Practice Address - Country:US
Practice Address - Phone:508-523-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN146297363L00000X
CT991363L00000X
MA261373171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004150257Medicaid
CT004150257Medicaid