Provider Demographics
NPI:1811105711
Name:DEMKOWICZ, JEANNINE MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:JEANNINE
Middle Name:MARIE
Last Name:DEMKOWICZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 AVON DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2115
Mailing Address - Country:US
Mailing Address - Phone:508-754-3158
Mailing Address - Fax:508-845-2783
Practice Address - Street 1:214 LAKE ST
Practice Address - Street 2:CHILD DEVELOPMENT CENTER
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3960
Practice Address - Country:US
Practice Address - Phone:508-856-4202
Practice Address - Fax:508-845-2783
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197317163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics