Individual
IRIS VICENCIO-RASKU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
150 S HUNTINGTON AVE BLDG 9, JAMAICA PLAIN, MA 02130-4817
(413) 584-4040
(857) 364-6003
Mailing address
150 S HUNTINGTON AVE BLDG 9, JAMAICA PLAIN, MA 02130-4817
(413) 584-4040
(857) 364-6003
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN276885
MA
363LA2200X
Adult Health Nurse Practitioner
Primary
RN276885
MA
363LF0000X
Family Nurse Practitioner
RN276885
MA
Other
Enumeration date
03/10/2017
Last updated
09/02/2025
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