Provider Demographics
NPI:1780259986
Name:CICCHESE, JOLENE (RN)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:CICCHESE
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 1:25 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02532-3106
Mailing Address - Country:US
Mailing Address - Phone:508-631-3223
Mailing Address - Fax:508-759-7880
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02532-3106
Practice Address - Country:US
Practice Address - Phone:508-631-3223
Practice Address - Fax:508-759-7880
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262466163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty