Provider Demographics
NPI:1225108954
Name:BOBOLIA, JENNIFER B (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:B
Last Name:BOBOLIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:GAGNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:248 PLEASANT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2588
Mailing Address - Country:US
Mailing Address - Phone:603-230-1220
Mailing Address - Fax:603-230-1225
Practice Address - Street 1:248 PLEASANT ST STE 202
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2588
Practice Address - Country:US
Practice Address - Phone:603-230-1220
Practice Address - Fax:603-230-1225
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234253363LF0000X
NH067679-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003132727Medicaid
MA0706493Medicaid
MA0706493Medicaid
CT003132727Medicaid