1255340469 NPI number — MS. JENNIFER ANNE GANEM MS, APRN

Table of content: MS. JENNIFER ANNE GANEM MS, APRN (NPI 1255340469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255340469 NPI number — MS. JENNIFER ANNE GANEM MS, APRN

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAFOND
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
GANEM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255340469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 NASHUA RD STE 208
Provider Second Line Business Mailing Address:
LONDONDERRY SQUARE
Provider Business Mailing Address City Name:
LONDONDERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03053-3438
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-432-3399
Provider Business Mailing Address Fax Number:
603-432-3396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 NASHUA RD STE 208
Provider Second Line Business Practice Location Address:
LONDONDERRY SQUARE
Provider Business Practice Location Address City Name:
LONDONDERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03053-3438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-432-3399
Provider Business Practice Location Address Fax Number:
603-432-3396
Provider Enumeration Date:
08/05/2006

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: 363LP0808X , with the licence number:  0374162308 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 037416-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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