Healthcare Provider Details

I. General information

NPI: 1093075673
Provider Name (Legal Business Name): JENNIFER W O'BRIEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER KURTZ CRNA

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LIMBO LN
AMHERST NH
03031-1871
US

IV. Provider business mailing address

84 FOXBERRY DR
NEW BOSTON NH
03070-4315
US

V. Phone/Fax

Practice location:
  • Phone: 908-392-0381
  • Fax:
Mailing address:
  • Phone: 908-392-0381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number069710-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN270285
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: