Provider Demographics
NPI:1063203446
Name:LAGHETTO, JAKE (NP)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:LAGHETTO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MILL VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02779-1727
Mailing Address - Country:US
Mailing Address - Phone:508-269-9525
Mailing Address - Fax:
Practice Address - Street 1:1 MILL VILLAGE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MA
Practice Address - Zip Code:02779-1727
Practice Address - Country:US
Practice Address - Phone:508-269-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2309806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner