Provider Demographics
NPI:1326658790
Name:HOLGERSEN, JEANNE MARIE
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:HOLGERSEN
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 1:365 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1637
Mailing Address - Country:US
Mailing Address - Phone:617-846-5352
Mailing Address - Fax:617-846-1062
Practice Address - Street 1:217 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-3012
Practice Address - Country:US
Practice Address - Phone:617-970-9287
Practice Address - Fax:617-539-1575
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2291455363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care