Provider Demographics
NPI:1851025662
Name:CENSULLO, JACQUELYN CAROL (RN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:CAROL
Last Name:CENSULLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BULFINCH TER
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-1021
Mailing Address - Country:US
Mailing Address - Phone:781-724-1796
Mailing Address - Fax:
Practice Address - Street 1:41 BULFINCH TER
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-1021
Practice Address - Country:US
Practice Address - Phone:781-724-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2261610363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner