Healthcare Provider Details

I. General information

NPI: 1104048313
Provider Name (Legal Business Name): JENNIFER A PINARD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 SOUTH MAIN STREET SUITE J
WOLFEBORO NH
03894-4411
US

IV. Provider business mailing address

P O BOX 912
WOLFEBORO NH
03894-0912
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-7588
  • Fax: 603-569-7589
Mailing address:
  • Phone: 603-569-7588
  • Fax: 603-569-7588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNH0524282303
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number052428-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: