Individual
JASON MISHOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-7688
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2621
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2274679
MA
363L00000X
Nurse Practitioner
Primary
RN2274679
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
RN2274679
MA
Other
Enumeration date
06/28/2019
Last updated
01/14/2021
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