1184657801 NPI number — MS. JENNIFER LYNNE WILSON APRN

Table of content: MS. JENNIFER LYNNE WILSON APRN (NPI 1184657801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184657801 NPI number — MS. JENNIFER LYNNE WILSON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
JENNIFER
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARZETTE
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184657801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 810
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03755-0810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-308-1467
Provider Business Mailing Address Fax Number:
850-863-4152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HITCHCOCK WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03104-4125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-695-2500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  042212-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: ARNP9200345 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 306147700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y047K . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 003428100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".