Provider Demographics
NPI:1518189851
Name:ROLLOCK DURETTE, JACQUELINE G (RN,MSN,BC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:G
Last Name:ROLLOCK DURETTE
Suffix:
Gender:F
Credentials:RN,MSN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 COTUIT RD
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1834
Mailing Address - Country:US
Mailing Address - Phone:508-428-3698
Mailing Address - Fax:508-428-0005
Practice Address - Street 1:230 COTUIT RD
Practice Address - Street 2:
Practice Address - City:MARSTONS MILLS
Practice Address - State:MA
Practice Address - Zip Code:02648-1834
Practice Address - Country:US
Practice Address - Phone:508-428-3698
Practice Address - Fax:508-428-0005
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128919163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health