Provider Demographics
NPI:1336358837
Name:SACKETT, MARY-JANE (RN, IBCLC, CCE, CD)
Entity Type:Individual
Prefix:
First Name:MARY-JANE
Middle Name:
Last Name:SACKETT
Suffix:
Gender:F
Credentials:RN, IBCLC, CCE, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-1775
Mailing Address - Country:US
Mailing Address - Phone:413-446-3942
Mailing Address - Fax:
Practice Address - Street 1:142 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-1775
Practice Address - Country:US
Practice Address - Phone:413-446-3942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA107386163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant