Provider Demographics
NPI:1407226160
Name:BAI, JENNIFER R (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:BAI
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 SUMMER STREET
Mailing Address - Street 2:UNIT 16
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-1139
Mailing Address - Country:US
Mailing Address - Phone:917-659-8300
Mailing Address - Fax:
Practice Address - Street 1:525 LONG POND DR
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-1227
Practice Address - Country:US
Practice Address - Phone:917-659-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2311919363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health