Individual
MS. JACQUELINE MEDEIROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2150 MAIN ST, SPRINGFIELD, MA 01104-3566
(413) 733-0010
(413) 930-2108
Mailing address
PO BOX 366, LUDLOW, MA 01056-0366
(413) 733-0010
(413) 930-2108
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
119372
MA
363LA2200X
Adult Health Nurse Practitioner
002624
CT
363LA2200X
Adult Health Nurse Practitioner
119372
MA
Other
Enumeration date
11/03/2005
Last updated
03/13/2019
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