Provider Demographics
NPI:1467757047
Name:ASHBY, JENNA MARIE (PAC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:ASHBY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-2504
Mailing Address - Country:US
Mailing Address - Phone:603-622-6484
Mailing Address - Fax:603-647-8593
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-224-2556
Practice Address - Fax:603-226-5821
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0818OtherMEDICAL LIC
NH1096709OtherNCCPA
NH0818OtherMEDICAL LIC