Basic Information
| Provider Information | |||||||||
| NPI: | 1740645084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JABBOUR | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RN, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 FRAIRY ST APT 304 | ||||||||
| Address2: | |||||||||
| City: | MEDFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020521631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3392250219 | ||||||||
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| Practice Location | |||||||||
| Address1: | 855 WORCESTER RD | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017015258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085212287 | ||||||||
| FaxNumber: | 5085805162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2015 | ||||||||
| LastUpdateDate: | 12/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0807X | RN 2275049 | MA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent |
No ID Information.