Provider Demographics
NPI:1093153959
Name:PENN, JENNIFER A (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:PENN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:PATEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:39 SIMON ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3043
Mailing Address - Country:US
Mailing Address - Phone:603-888-4347
Mailing Address - Fax:
Practice Address - Street 1:39 SIMON ST STE 2A
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3043
Practice Address - Country:US
Practice Address - Phone:603-888-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH067851-21163W00000X
NH067851-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3092163Medicaid