Provider Demographics
NPI:1639214893
Name:MACHAIN, JACQUELINE L (ACNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:MACHAIN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 WASHINGTON ST
Mailing Address - Street 2:GREEN MOB SUITE 561
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1607
Mailing Address - Country:US
Mailing Address - Phone:617-244-1214
Mailing Address - Fax:617-244-0848
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:GREEN MOB SUITE 561
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-244-1214
Practice Address - Fax:617-244-0848
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA254598363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care