Provider Demographics
NPI:1265178313
Name:ACEVEDO, JERICA (LPN)
Entity type:Individual
Prefix:MS
First Name:JERICA
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JERICA
Other - Middle Name:
Other - Last Name:ACEVEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:56 PRINCESS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01129-1819
Mailing Address - Country:US
Mailing Address - Phone:413-378-8898
Mailing Address - Fax:
Practice Address - Street 1:56 PRINCESS RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01129-1819
Practice Address - Country:US
Practice Address - Phone:413-378-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN93047164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse