Provider Demographics
NPI:1518189752
Name:WISHINGSTONE, JEAN (NP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:WISHINGSTONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-4315
Mailing Address - Country:US
Mailing Address - Phone:207-514-3153
Mailing Address - Fax:
Practice Address - Street 1:124 WHEELER RD
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-4315
Practice Address - Country:US
Practice Address - Phone:207-514-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN255104363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432540599Medicaid