MEDICARE: MRS. JENNA KRISTINA REARDON ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	057510-23	NH

General Provider Information

NPI Number	:	1154575710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNA KRISTINA REARDON ARNP

Provider Business Mailing Address
First Line	:	18 FOUNDRY ST
Second Line	:	SUITE 201
City	:	CONCORD
State	:	NH
Zip	:	03301-5419
Country	:	US
Telephone Number	:	603-228-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 FOUNDRY ST
Second Line	:	SUITE 201
City	:	CONCORD
State	:	NH
Zip	:	03301-5419
Country	:	US
Telephone Number	:	603-228-0071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	11/10/2008

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