Provider Demographics
NPI:1629790928
Name:MACINNES, JESSIE KIMELMAN
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:KIMELMAN
Last Name:MACINNES
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 1:4 KALIA CIR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-6311
Mailing Address - Country:US
Mailing Address - Phone:508-451-7329
Mailing Address - Fax:
Practice Address - Street 1:26 PARKRIDGE RD STE 2B
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01835-8515
Practice Address - Country:US
Practice Address - Phone:978-374-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program