Healthcare Provider Details

I. General information

NPI: 1770337032
Provider Name (Legal Business Name): JENNIFER MAMROL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 BRIDGE WAY
PASCOAG RI
02859-3131
US

IV. Provider business mailing address

542 PROVIDENCE RD
BROOKLYN CT
06234-3413
US

V. Phone/Fax

Practice location:
  • Phone: 401-568-7661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN03769
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN03769
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15454
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: