Provider Demographics
NPI:1538136684
Name:KALES, JENNIFER (ANP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KALES
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:TOWER 1 NURSING ADMIN
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-632-6464
Mailing Address - Fax:617-632-6180
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:TOWER 1 NURSING ADMINISTRATION
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-632-6464
Practice Address - Fax:617-632-6180
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN224535363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02683021Medicaid
MA001345701OtherMEDICARE ID
MA001345701OtherMEDICARE ID