Provider Demographics
NPI:1497206817
Name:DEWEESE, JONATHAN PATRICK (MSN, NP-C, PMHNP)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PATRICK
Last Name:DEWEESE
Suffix:
Gender:M
Credentials:MSN, NP-C, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 WESTERN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3702
Mailing Address - Country:US
Mailing Address - Phone:617-466-9083
Mailing Address - Fax:617-485-1950
Practice Address - Street 1:141 WESTERN AVE APT 1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3702
Practice Address - Country:US
Practice Address - Phone:517-927-2831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2291351363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner