Healthcare Provider Details

I. General information

NPI: 1154575710
Provider Name (Legal Business Name): JENNA KRISTINA REARDON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 FOUNDRY ST SUITE 201
CONCORD NH
03301-5419
US

IV. Provider business mailing address

18 FOUNDRY ST SUITE 201
CONCORD NH
03301-5419
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-0071
  • Fax:
Mailing address:
  • Phone: 603-228-0071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number057510-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: