Provider Demographics
NPI:1619152303
Name:PETRONE, JESSICA N
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:PETRONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1205
Mailing Address - Country:US
Mailing Address - Phone:508-295-0237
Mailing Address - Fax:
Practice Address - Street 1:294 PLEASANT ST # 206
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2571
Practice Address - Country:US
Practice Address - Phone:508-254-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-01
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2331061.163WC1500X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health