Individual
JACQUELINE ANN BERUBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
100 SOUTH ST, SOUTHBRIDGE, MA 01550-4051
(508) 765-9771
Mailing address
64 ALLEN RD, STURBRIDGE, MA 01566-1018
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN211198
MA
363L00000X
Nurse Practitioner
Primary
RN211198
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110146322A
—
MA
Enumeration date
09/17/2018
Last updated
08/08/2023
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