Provider Demographics
NPI:1750501508
Name:WAITNEIGHT, JEAN A (MSN, PMHNP-BC,PNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:A
Last Name:WAITNEIGHT
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC,PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1612
Mailing Address - Country:US
Mailing Address - Phone:617-969-8989
Mailing Address - Fax:
Practice Address - Street 1:299 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1612
Practice Address - Country:US
Practice Address - Phone:617-969-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN258646363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP9639OtherBCBSMA