Provider Demographics
NPI:1043802119
Name:DOUGLAS, JENNIFER J
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:J
Last Name:DOUGLAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WARD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-7145
Mailing Address - Country:US
Mailing Address - Phone:860-926-4657
Mailing Address - Fax:860-454-7220
Practice Address - Street 1:7 WARD ST APT 2
Practice Address - Street 2:
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-7145
Practice Address - Country:US
Practice Address - Phone:860-926-4657
Practice Address - Fax:860-454-7220
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider