Provider Demographics
NPI:1952081929
Name:MAMON, JOELLE FERN (NP)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:FERN
Last Name:MAMON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:617-414-6031
Practice Address - Street 1:830 HARRISON AVE FL 3
Practice Address - Street 2:MOAKLEY BUILDING, HEMATOLOGY & ONCOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2905
Practice Address - Country:US
Practice Address - Phone:617-638-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-08-30
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Provider Licenses
StateLicense IDTaxonomies
MARN2308737363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner