Provider Demographics
NPI:1609609213
Name:JEAN PHILIPPE, ERSON (APRN)
Entity type:Individual
Prefix:
First Name:ERSON
Middle Name:
Last Name:JEAN PHILIPPE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:ERSON
Other - Middle Name:
Other - Last Name:JEAN-PHILIPPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:23 WHINEYS WAY
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-4457
Mailing Address - Country:US
Mailing Address - Phone:781-363-7533
Mailing Address - Fax:
Practice Address - Street 1:23 WHINEYS WAY
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-4457
Practice Address - Country:US
Practice Address - Phone:781-363-7533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2319358363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty