Provider Demographics
NPI:1043720840
Name:JENNINGS, JOYCE KATHERINE (RN)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:KATHERINE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:K
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9 BASSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-1603
Mailing Address - Country:US
Mailing Address - Phone:617-839-5434
Mailing Address - Fax:
Practice Address - Street 1:9 BASSWOOD AVE
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-1603
Practice Address - Country:US
Practice Address - Phone:617-839-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN204661163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice