Healthcare Provider Details

I. General information

NPI: 1568820595
Provider Name (Legal Business Name): JENNIFER R OWENS AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HUNT ST
NASHUA NH
03060-4426
US

IV. Provider business mailing address

22 HUNT ST
NASHUA NH
03060-4426
US

V. Phone/Fax

Practice location:
  • Phone: 781-867-2050
  • Fax:
Mailing address:
  • Phone: 781-867-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2262174
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2262174
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number086867-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: