1679765465 NPI number — MRS. JILLIAN LEIGH OPPENHEIM APRN BC FNP

Table of content: MRS. JILLIAN LEIGH OPPENHEIM APRN BC FNP (NPI 1679765465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679765465 NPI number — MRS. JILLIAN LEIGH OPPENHEIM APRN BC FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OPPENHEIM
Provider First Name:
JILLIAN
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN BC FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679765465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38R ENON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-927-7717
Provider Business Mailing Address Fax Number:
978-927-4598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
STE. 101
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01970-2185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-740-2300
Provider Business Practice Location Address Fax Number:
978-744-3993
Provider Enumeration Date:
08/15/2007

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: 363L00000X , with the licence number:  267909 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0715522 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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