Healthcare Provider Details

I. General information

NPI: 1447992789
Provider Name (Legal Business Name): JENNIFER L POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 WEBSTER ST
HANOVER MA
02339-1262
US

IV. Provider business mailing address

222 WEBSTER ST
HANOVER MA
02339-1262
US

V. Phone/Fax

Practice location:
  • Phone: 781-421-6544
  • Fax:
Mailing address:
  • Phone: 781-421-6544
  • Fax: 781-421-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN261450
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN261450
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: