Healthcare Provider Details

I. General information

NPI: 1750956710
Provider Name (Legal Business Name): JENNIFER MARIE LAPORTE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CIRCLE AVE
LYNN MA
01905-3050
US

IV. Provider business mailing address

9 MORTON ST
MALDEN MA
02148-3227
US

V. Phone/Fax

Practice location:
  • Phone: 781-595-2413
  • Fax: 781-595-0773
Mailing address:
  • Phone: 857-249-2284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN2306463
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: