Provider Demographics
NPI:1669074308
Name:POOMCHAROEN, JILLIAN BLANCHE (NP)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:BLANCHE
Last Name:POOMCHAROEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:287 CHAUNCY ST UNIT C302
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1182
Mailing Address - Country:US
Mailing Address - Phone:401-309-1541
Mailing Address - Fax:
Practice Address - Street 1:60 MESSENGER ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2258
Practice Address - Country:US
Practice Address - Phone:508-809-6378
Practice Address - Fax:508-342-1912
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2305937163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse