Provider Demographics
NPI:1083310056
Name:SZELOG, JENNIFER SARA (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SARA
Last Name:SZELOG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SARA
Other - Last Name:FREITAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:11 KIMBALL DR UNIT 125
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-2623
Mailing Address - Country:US
Mailing Address - Phone:603-622-6484
Mailing Address - Fax:603-647-8593
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7559
Practice Address - Country:US
Practice Address - Phone:603-622-6484
Practice Address - Fax:603-647-8593
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH079546-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner