Provider Demographics
NPI:1013785500
Name:JOSEPH, JACKIE ANNE
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:ANNE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 CENTRE ST APT 608
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2777
Mailing Address - Country:US
Mailing Address - Phone:617-935-3777
Mailing Address - Fax:
Practice Address - Street 1:147 CENTRE ST APT 608
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2777
Practice Address - Country:US
Practice Address - Phone:617-935-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula