1477869758 NPI number — MISS JACQUELYN ANN STOKES LADCA

Table of content: MISS JACQUELYN ANN STOKES LADCA (NPI 1477869758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477869758 NPI number — MISS JACQUELYN ANN STOKES LADCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOKES
Provider First Name:
JACQUELYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LADCA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
JACQUELYN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LADCA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477869758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
157 GREEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMAICA PLAIN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02130-2667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-983-5800
Provider Business Mailing Address Fax Number:
617-983-5840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157 GREEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA PLAIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02130-2667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-983-5800
Provider Business Practice Location Address Fax Number:
617-983-5840
Provider Enumeration Date:
08/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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