Provider Demographics
NPI:1871663989
Name:FIELEKE, JILL A (NP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:FIELEKE
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 1:3 FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1216
Mailing Address - Country:US
Mailing Address - Phone:857-205-0441
Mailing Address - Fax:
Practice Address - Street 1:173 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4005
Practice Address - Country:US
Practice Address - Phone:617-903-5900
Practice Address - Fax:618-618-6028
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228571NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RN0287OtherMEDICARE ID