Healthcare Provider Details

I. General information

NPI: 1154094530
Provider Name (Legal Business Name): JENNELLE ANN GUIOD APRN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 06/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BOULDER POINT DR STE 1
PLYMOUTH NH
03264-3170
US

IV. Provider business mailing address

21 SEARLE HILL RD
DANBURY NH
03230-4314
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number071414-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: