Healthcare Provider Details

I. General information

NPI: 1083053714
Provider Name (Legal Business Name): DR. JENNIFER DINEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2013
Last Update Date: 06/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. VINCENTS UNIVERSITY HOSPITAL DEPARTMENT OF NEUROLOGY
DUBLIN 0
4
IE

IV. Provider business mailing address

4 MANOR GROVE, BLACKWATER
CLARE 0
0
IE

V. Phone/Fax

Practice location:
  • Phone: 86-837-9119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number255061
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: