Healthcare Provider Details

I. General information

NPI: 1679557987
Provider Name (Legal Business Name): JENNIFER CATHERINE AMON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER CATHERINE OSTRANDER CPNP

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 LONGWATER DR
NORWELL MA
02061-1683
US

IV. Provider business mailing address

143 LONGWATER DR
NORWELL MA
02061-1683
US

V. Phone/Fax

Practice location:
  • Phone: 781-878-5200
  • Fax:
Mailing address:
  • Phone: 781-878-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number300264
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number300264
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number300264
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN1008418
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP60023099
License Number StateWA
# 6
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2299302
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: