Provider Demographics
NPI:1477860401
Name:JELLIFFE, JENNY BEATRIX (MSN)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:BEATRIX
Last Name:JELLIFFE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DEXTER AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4238
Mailing Address - Country:US
Mailing Address - Phone:617-600-3195
Mailing Address - Fax:617-924-1207
Practice Address - Street 1:200 DEXTER AVE
Practice Address - Street 2:SUITE K
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4238
Practice Address - Country:US
Practice Address - Phone:617-600-3195
Practice Address - Fax:617-924-1207
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA198155163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology