Provider Demographics
NPI:1982685186
Name:NDEGWA, JANE W (NP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:W
Last Name:NDEGWA
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:PO BOX 3904
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01961-3904
Mailing Address - Country:US
Mailing Address - Phone:781-883-2919
Mailing Address - Fax:
Practice Address - Street 1:200 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOXFORD
Practice Address - State:MA
Practice Address - Zip Code:01921-1017
Practice Address - Country:US
Practice Address - Phone:781-962-3060
Practice Address - Fax:978-824-3872
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0701556Medicaid
MA0701556Medicaid
MANP5038Medicare ID - Type Unspecified