Provider Demographics
NPI:1164291092
Name:STABILE, JENNIFER LYN (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:STABILE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 ROCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-1926
Mailing Address - Country:US
Mailing Address - Phone:401-647-0407
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-384-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03851363LA2100X
CT12896363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care