Provider Demographics
NPI:1407446909
Name:KOESTER, JENNIFER L (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:KOESTER
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 BISHOP HILL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-2826
Mailing Address - Country:US
Mailing Address - Phone:815-291-5637
Mailing Address - Fax:
Practice Address - Street 1:5 PRECINCT ST
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1468
Practice Address - Country:US
Practice Address - Phone:508-947-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2337272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty