=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083846760
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER L RICHARDSON FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2009
-----------------------------------------------------
Last Update Date | 06/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 DONALD'S WAY
-----------------------------------------------------
City | EAST BRIDGEWATER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-941-7100
-----------------------------------------------------
Fax | 508-894-0412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 DONALD'S WAY
-----------------------------------------------------
City | EAST BRIDGEWATER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02333-1148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-941-7100
-----------------------------------------------------
Fax | 508-894-0412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2009007598
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN278952
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------