MEDICARE: JENNIFER T. PHAN ANP

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	207Q00000X	Family Medicine Physician	RN2264825	MA

General Provider Information

NPI Number	:	1538443460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER T. PHAN ANP

Provider Business Mailing Address
First Line	:	145 ROSEMARY STREET
Second Line	:	SUITE C
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3259
Country	:	US
Telephone Number	:	781-235-7900
Fax Number	:	781-237-9930

Provider Business Practice Location Address
First Line	:	145 ROSEMARY STREET
Second Line	:	SUITE C
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3259
Country	:	US
Telephone Number	:	781-235-7900
Fax Number	:	781-237-9930

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

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	03/03/2026

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