Basic Information
| Provider Information | |||||||||
| NPI: | 1144626904 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JODREY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | GEORGE | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 CHATHAM VILLAGE RD | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016063112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088520118 | ||||||||
| FaxNumber: | 5088520118 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021181951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8572067545 | ||||||||
| FaxNumber: | 6174252031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2014 | ||||||||
| LastUpdateDate: | 11/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | MA 59035 | MA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.