Provider Demographics
NPI:1467633321
Name:JARDIN, KRISANN (CNM)
Entity Type:Individual
Prefix:
First Name:KRISANN
Middle Name:
Last Name:JARDIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BRIGHAM ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2208
Mailing Address - Country:US
Mailing Address - Phone:508-999-6245
Mailing Address - Fax:508-999-9442
Practice Address - Street 1:60 BRIGHAM ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2208
Practice Address - Country:US
Practice Address - Phone:508-999-6245
Practice Address - Fax:508-999-9442
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218173367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife