Provider Demographics
NPI:1023002649
Name:MARROCCO, JEANINE E (ANP)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:E
Last Name:MARROCCO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEETING HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2700
Mailing Address - Country:US
Mailing Address - Phone:978-256-5522
Mailing Address - Fax:978-256-5885
Practice Address - Street 1:2 MEETING HOUSE RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2700
Practice Address - Country:US
Practice Address - Phone:978-256-5522
Practice Address - Fax:978-256-5885
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA137978363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4259Medicare ID - Type UnspecifiedMEDICARE NUMBER
MAP96667Medicare UPIN