Provider Demographics
NPI:1750973848
Name:TOLO, JENNIFER WREN (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WREN
Last Name:TOLO
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 1:49 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MA
Mailing Address - Zip Code:01929-1219
Mailing Address - Country:US
Mailing Address - Phone:978-290-1938
Mailing Address - Fax:
Practice Address - Street 1:49 MARTIN ST
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MA
Practice Address - Zip Code:01929-1219
Practice Address - Country:US
Practice Address - Phone:978-290-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X, 174H00000X
MARN244625163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN244625OtherOFFICE OF HEALTH AND HUMAN SERVICES