Provider Demographics
NPI:1407857378
Name:JENEST, HELEN (NURSE PRACTIONER)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:JENEST
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0908
Mailing Address - Country:US
Mailing Address - Phone:617-417-0033
Mailing Address - Fax:617-770-4354
Practice Address - Street 1:500 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0908
Practice Address - Country:US
Practice Address - Phone:617-417-0033
Practice Address - Fax:617-770-4354
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152529363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0700118Medicaid
MA0700118Medicaid
MANP0185Medicare ID - Type Unspecified