Provider Demographics
NPI:1164716981
Name:RESKE-NIELSEN, JENNIFER JANE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JANE
Last Name:RESKE-NIELSEN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 BERKELEY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5100
Mailing Address - Country:US
Mailing Address - Phone:617-927-6300
Mailing Address - Fax:
Practice Address - Street 1:142 BERKELEY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5100
Practice Address - Country:US
Practice Address - Phone:617-927-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248277207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine