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NPI Code Detail

MEDICARE: MRS. JENNIFER LEIGH REARDON FNP

MEDICARE: MRS. JENNIFER LEIGH REARDON FNP
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
1363LF0000XFamily Nurse PractitionerCNP241693ME
2163WN0002XNeonatal Intensive Care Registered Nurse200441874OR
3163WH0200XHome Health Registered Nurse60699055WA
4363LF0000XFamily Nurse Practitioner10000620OR

General Provider Information

NPI Number : 1902405582
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER LEIGH REARDON FNP
Provider Business Mailing Address
First Line : 360 US HIGHWAY 1 BYP UNIT 102
Second Line :
City : PORTSMOUTH
State : NH
Zip : 03801-7105
Country : US
Telephone Number : 603-410-6700
Fax Number :
Provider Business Practice Location Address
First Line : 193 BATH RD
Second Line :
City : BRUNSWICK
State : ME
Zip : 04011-2607
Country : US
Telephone Number : 207-424-2272
Fax Number : 207-424-2268
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2020
Last Update Date : 11/06/2025

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