Individual
MR. JAKE FORREST VISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
20 VESPER LN, NANTUCKET, MA 02554-4394
(508) 228-2689
(508) 228-3613
Mailing address
20 VESPER LN, NANTUCKET, MA 02554-4394
(508) 228-2689
(508) 228-3613
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/17/2015
Last updated
04/17/2015
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