Provider Demographics
NPI:1235375114
Name:WILLARD, JENNIFER HASTINGS (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HASTINGS
Last Name:WILLARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:HASTINGS
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-664-2135
Mailing Address - Fax:603-664-9128
Practice Address - Street 1:8 CENTURY PINES DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BARRINGTON
Practice Address - State:NH
Practice Address - Zip Code:03825-3732
Practice Address - Country:US
Practice Address - Phone:603-664-2135
Practice Address - Fax:603-664-9128
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH060461-23363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075371Medicaid
ME1235375114Medicaid
NHP00709637OtherRR MEDICARE
ME1235375114Medicaid