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NPI Code Detail

MEDICARE: JENNIFER FENN

MEDICARE: JENNIFER FENN
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
1363LP2300XPrimary Care Nurse Practitioner101.0101947VT

General Provider Information

NPI Number : 1295152676
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER FENN
Provider Business Mailing Address
First Line : 26 CANADA ST
Second Line :
City : SWANTON
State : VT
Zip : 05488-1335
Country : US
Telephone Number : 802-868-2454
Fax Number :
Provider Business Practice Location Address
First Line : 26 CANADA ST
Second Line :
City : SWANTON
State : VT
Zip : 05488-1335
Country : US
Telephone Number : 802-868-2454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2014
Last Update Date : 06/09/2016

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