Healthcare Provider Details

I. General information

NPI: 1437931748
Provider Name (Legal Business Name): JENNIFER ALFRED MSN, ACNP-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LEPAGE MSN, ACNP-AG

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BLACKSTONE VALLEY PLACE BLDG 3, SUITE 306B
LINCOLN RI
02865-1112
US

IV. Provider business mailing address

132 OLD RIVER RD STE 108
LINCOLN RI
02865-1397
US

V. Phone/Fax

Practice location:
  • Phone: 401-723-9250
  • Fax:
Mailing address:
  • Phone: 401-723-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2322210
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: