Healthcare Provider Details

I. General information

NPI: 1578122420
Provider Name (Legal Business Name): JENNIFER YERGEAU APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO
CONCORD NH
03301-2548
US

IV. Provider business mailing address

246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO
CONCORD NH
03301-2548
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-6070
  • Fax: 603-227-7555
Mailing address:
  • Phone: 603-224-6070
  • Fax: 603-227-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number049053-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: