Healthcare Provider Details

I. General information

NPI: 1407772312
Provider Name (Legal Business Name): JACQUELYNN KATE RONDEAU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 SHORE DR STE 501
WORCESTER MA
01605-3154
US

IV. Provider business mailing address

10 SEAN DR
WHITINSVILLE MA
01588-1240
US

V. Phone/Fax

Practice location:
  • Phone: 508-756-6609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2343847
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: