Provider Demographics
NPI:1508446600
Name:DRANE, JACQUELINE MARIE (RN, MFP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIE
Last Name:DRANE
Suffix:
Gender:F
Credentials:RN, MFP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PLAIN ST
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1344
Mailing Address - Country:US
Mailing Address - Phone:508-330-7297
Mailing Address - Fax:
Practice Address - Street 1:60 PLAIN ST
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568-1344
Practice Address - Country:US
Practice Address - Phone:508-330-7297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197825163WD1100X
MA44122782224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal