Provider Demographics
NPI:1174766901
Name:PAGANO-THERRIEN, JESICA (MSN, RN, CPNP)
Entity type:Individual
Prefix:
First Name:JESICA
Middle Name:
Last Name:PAGANO-THERRIEN
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:PEDIATRICS, BENEDICT A3-115
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-2319
Practice Address - Fax:508-856-1733
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2020-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN267513363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics