Provider Demographics
NPI:1780933317
Name:BURNS, JENNIFER N
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:N
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:N
Other - Last Name:DOLECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-1703
Mailing Address - Country:US
Mailing Address - Phone:860-738-6250
Mailing Address - Fax:
Practice Address - Street 1:47 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-1703
Practice Address - Country:US
Practice Address - Phone:860-738-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0012288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist