Provider Demographics
NPI:1922468842
Name:LAURENT, JENNIE (RN)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:LAURENT
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 1:114 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01529-1640
Mailing Address - Country:US
Mailing Address - Phone:508-965-3053
Mailing Address - Fax:
Practice Address - Street 1:114 GROVE ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:MA
Practice Address - Zip Code:01529-1640
Practice Address - Country:US
Practice Address - Phone:508-965-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281690163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2281690OtherMA BOARD OF NURSING