Provider Demographics
NPI:1407618028
Name:HANLON, JEANNE B (RN,IBCLC,CBE)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:B
Last Name:HANLON
Suffix:
Gender:F
Credentials:RN,IBCLC,CBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PEMBERTON RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-4818
Mailing Address - Country:US
Mailing Address - Phone:508-380-5651
Mailing Address - Fax:
Practice Address - Street 1:76 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-4908
Practice Address - Country:US
Practice Address - Phone:744-421-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154139163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant