MEDICARE: JENNA M CHERENZIA ATC

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	2255A2300X	Athletic Trainer	0336	NH

General Provider Information

NPI Number	:	1225165707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA M CHERENZIA ATC

Provider Business Mailing Address
First Line	:	40 KUEHN RD
Second Line	:	PO BOX 23
City	:	HOPKINTON
State	:	RI
Zip	:	02833
Country	:	US
Telephone Number	:	401-742-5238
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 MAIN ST
Second Line	:	UNIVERSITY OF NEW HAMPSHIRE
City	:	DURHAM
State	:	NH
Zip	:	03824-3572
Country	:	US
Telephone Number	:	603-862-4987
Fax Number	:

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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