MEDICARE: JACQUELINE G ROLLOCK DURETTE R.N.,M.S.N.,B.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	128919	MA

General Provider Information

NPI Number	:	1518189851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE G ROLLOCK DURETTE R.N.,M.S.N.,B.C.

Provider Business Mailing Address
First Line	:	230 COTUIT RD
Second Line	:
City	:	MARSTONS MILLS
State	:	MA
Zip	:	02648-1834
Country	:	US
Telephone Number	:	508-428-3698
Fax Number	:	508-428-0005

Provider Business Practice Location Address
First Line	:	230 COTUIT RD
Second Line	:
City	:	MARSTONS MILLS
State	:	MA
Zip	:	02648-1834
Country	:	US
Telephone Number	:	508-428-3698
Fax Number	:	508-428-0005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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