Provider Demographics
NPI:1912251794
Name:METIVIER, JEAN-ELLEN MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JEAN-ELLEN
Middle Name:MARIE
Last Name:METIVIER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:JEAN-ELLEN
Other - Middle Name:MARIE
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MA
Mailing Address - Street 1:186 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-1663
Mailing Address - Country:US
Mailing Address - Phone:802-751-0694
Mailing Address - Fax:
Practice Address - Street 1:269 UNION ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1314
Practice Address - Country:US
Practice Address - Phone:781-581-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program