Provider Demographics
NPI:1427324631
Name:DEMARCO, JENNIFER ELLEN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLEN
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 EDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2829
Mailing Address - Country:US
Mailing Address - Phone:508-212-7284
Mailing Address - Fax:
Practice Address - Street 1:87 EDEN PARK DR
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-2829
Practice Address - Country:US
Practice Address - Phone:508-212-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN232714163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
14140570OtherCAQH