Provider Demographics
NPI:1295209625
Name:QUERO, JOANN MARY
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:MARY
Last Name:QUERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 CONNELL AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2543
Mailing Address - Country:US
Mailing Address - Phone:508-692-0699
Mailing Address - Fax:
Practice Address - Street 1:92 CONNELL AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2543
Practice Address - Country:US
Practice Address - Phone:508-692-0699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy