Healthcare Provider Details

I. General information

NPI: 1730637158
Provider Name (Legal Business Name): JENNIFER L. COLTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

IV. Provider business mailing address

5 BRENTWOOD WAY
IPSWICH MA
01938-1176
US

V. Phone/Fax

Practice location:
  • Phone: 617-421-1191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN2293462
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: