Provider Demographics
NPI:1497532469
Name:DIBENEDETTO, JENNIFER K (PHD, APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:K
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:PHD, 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 1:10002A SHOPS WAY
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-4119
Mailing Address - Country:US
Mailing Address - Phone:774-500-7334
Mailing Address - Fax:
Practice Address - Street 1:10002A SHOPS WAY
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-4119
Practice Address - Country:US
Practice Address - Phone:774-500-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2286172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily