Provider Demographics
NPI:1134137821
Name:MASTROIANNI, JENNIE (RNC, MS, NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:
Last Name:MASTROIANNI
Suffix:
Gender:F
Credentials:RNC, MS, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2133
Mailing Address - Country:US
Mailing Address - Phone:508-435-5414
Mailing Address - Fax:
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:MIGS/REPRODUCTIVE MEDICINE UNIT- 2 NORTH
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1607
Practice Address - Country:US
Practice Address - Phone:617-243-5498
Practice Address - Fax:617-243-6922
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143919363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP1915Medicare ID - Type Unspecified