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General NPI Number Information
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NPI Number | 1538443460
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Entity Type | Individual
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Provider Name | JENNIFER TRINH PHAN ANP-C
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Gender | Female
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 266 MAIN ST STE 4
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City | MEDFIELD
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State | MA
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Zip | 02052-2018
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Country | US
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Telephone | 508-359-8141
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Fax | 508-359-8005
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Provider Business Mailing Address
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Address Line | 266 MAIN ST STE 4 P.O. BOX 469
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City | MEDFIELD
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State | MA
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Zip | 02052-2018
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Country | US
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Telephone | 508-359-8141
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Fax | 508-359-8005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN2264825
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License Number State | MA
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