Individual
MS. WALLASSE M JIMINAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17 JUDITH E. LN, METHUEN, MA 01844
(978) 397-5414
Mailing address
17 JUDITH E LN, METHUEN, MA 01844-4125
(978) 397-5414
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/23/2011
Last updated
02/23/2011
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