Provider Demographics
NPI:1538434634
Name:RAO, JENNIFER C (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:RAO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:C
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 METRO CENTER BOULEVARD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1768
Mailing Address - Country:US
Mailing Address - Phone:401-432-2500
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:125 METRO CENTER BOULEVARD
Practice Address - Street 2:SUITE 2000
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1768
Practice Address - Country:US
Practice Address - Phone:401-432-2500
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00355363A00000X, 363A00000X
MAPA2097363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical