Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 137978 | MA |
NPI | 1023002649 |
---|---|
Provider Name | Jeanine E Marrocco |
First Address | Chelmsford, MA 01824-2700 |
Second Address | Chelmsford, MA 01824-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P96667 | (02) | MA |