Individual
JILL T KOOYOOMJIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1 ESSEX CENTER DRIVE, LAHEY NORTHSHORE, PEABODY, MA 01960-4711
(978) 538-4370
(978) 538-4708
Mailing address
1 ESSEX CENTER DR., LAHEY CLINIC, PEABODY, MA 01960
(781) 674-1587
(781) 674-1200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
274888
MA
363L00000X
Nurse Practitioner
RN274888
MA
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
274888
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110080842A
—
MA
Enumeration date
10/17/2008
Last updated
06/10/2020
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