Provider Demographics
NPI:1194855189
Name:SKOGLUND, JENNIFER LYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYN
Last Name:SKOGLUND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 DAVIS CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:NEW DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03855-2222
Mailing Address - Country:US
Mailing Address - Phone:603-859-0636
Mailing Address - Fax:
Practice Address - Street 1:105 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2621
Practice Address - Country:US
Practice Address - Phone:207-741-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04726921163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health