Basic Information
Provider Information
NPI: 1326366444
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JUNG
FirstName: JOANNA
MiddleName: H.
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1731 WASHINGTON ST APT 9
Address2:  
City: BRAINTREE
State: MA
PostalCode: 021847927
CountryCode: US
TelephoneNumber: 6175492812
FaxNumber:  
Practice Location
Address1: 354 WAVERLEY ST
Address2:  
City: FRAMINGHAM
State: MA
PostalCode: 017027079
CountryCode: US
TelephoneNumber: 5082705700
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/13/2010
LastUpdateDate: 08/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X276840MAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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