Individual
MS. MICHELLE A JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1425 BLUE HILL AVENUE, MATTAPAN COMMUNITY HEALTH CENTER, MATTAPAN, MA 02126
(617) 898-9013
(617) 296-1421
Mailing address
5 SEIDEN ST, DORCHESTER, MA 02124
(617) 822-7523
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
252437
MA
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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