Individual
MRS. MARY LANE JACKMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
333 LONGWOOD AVE, 3RD FLOOR, BOSTON, MA 02115-5711
(617) 355-0648
(617) 730-0337
Mailing address
333 LONGWOOD AVE, 3RD FLOOR, BOSTON, MA 02115-5711
(617) 355-0648
(617) 730-0337
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2416
MA
363AS0400X
Surgical Physician Assistant
Primary
2416
MA
Other
Enumeration date
05/14/2008
Last updated
05/14/2008
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