Provider Demographics
NPI:1225409949
Name:NOVA, JENNIFER LEONELLYS
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEONELLYS
Last Name:NOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 COLGATE RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1105
Mailing Address - Country:US
Mailing Address - Phone:617-955-1606
Mailing Address - Fax:
Practice Address - Street 1:1613 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2123
Practice Address - Country:US
Practice Address - Phone:857-598-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program