Healthcare Provider Details

I. General information

NPI: 1922886225
Provider Name (Legal Business Name): LAUREN JEROME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN GREENBERG

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HERRICK ST
BEVERLY MA
01915-1790
US

IV. Provider business mailing address

41 MALL RD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-816-3700
  • Fax:
Mailing address:
  • Phone: 781-744-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number183870
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN10010266
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: