Provider Demographics
NPI:1295368579
Name:AWANDEM, JACOB ZIGO (RN)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ZIGO
Last Name:AWANDEM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CASHMAN RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-5726
Mailing Address - Country:US
Mailing Address - Phone:781-346-1858
Mailing Address - Fax:
Practice Address - Street 1:16 CASHMAN RD
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5726
Practice Address - Country:US
Practice Address - Phone:781-346-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2311448163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty