Healthcare Provider Details

I. General information

NPI: 1750361713
Provider Name (Legal Business Name): JEANNE B LAROCK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROSEBROOK WAY
WAREHAM MA
02571-1138
US

IV. Provider business mailing address

200 MILL RD STE 180
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-273-4950
  • Fax: 508-273-4950
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN216221
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number216221
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: