Provider Demographics
NPI:1427595529
Name:MASSOTTI, JENNIFER (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:MASSOTTI
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:DE
Mailing Address - Zip Code:19954-2001
Mailing Address - Country:US
Mailing Address - Phone:302-222-8251
Mailing Address - Fax:
Practice Address - Street 1:56 BROAD STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:DE
Practice Address - Zip Code:19954
Practice Address - Country:US
Practice Address - Phone:302-222-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0030542163WL0100X
DE11285831163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant