Provider Demographics
NPI:1639911191
Name:JIMENEZ, GISSELLE YOHANNA
Entity type:Individual
Prefix:
First Name:GISSELLE
Middle Name:YOHANNA
Last Name:JIMENEZ
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 1:75 W MILTON ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1929
Mailing Address - Country:US
Mailing Address - Phone:857-204-8023
Mailing Address - Fax:
Practice Address - Street 1:75 W MILTON ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1929
Practice Address - Country:US
Practice Address - Phone:857-204-8023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS21583734374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula