Healthcare Provider Details

I. General information

NPI: 1922476688
Provider Name (Legal Business Name): JESSICA E HAFFNER ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 STEWART TER
BELMONT MA
02478-3956
US

IV. Provider business mailing address

36 STEWART TER
BELMONT MA
02478-3956
US

V. Phone/Fax

Practice location:
  • Phone: 617-697-1917
  • Fax:
Mailing address:
  • Phone: 617-484-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN2270301
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number064299-21
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number642900
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2270303
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: