Provider Demographics
NPI:1700186947
Name:JEUDY, JOHANNE (NP)
Entity Type:Individual
Prefix:
First Name:JOHANNE
Middle Name:
Last Name:JEUDY
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Gender:F
Credentials:NP
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Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:732 HARRISON AVE, FL 2
Practice Address - Street 2:PRESTON BLDG
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2309
Practice Address - Country:US
Practice Address - Phone:617-638-7470
Practice Address - Fax:617-638-7449
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2023-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN267732363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110094697AMedicaid
MA003035901Medicare PIN