Provider Demographics
NPI:1538495791
Name:FORD, JENNIFER ANN (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:FORD
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Gender:F
Credentials:NP
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Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:SHAPIRO 5
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-8807
Mailing Address - Fax:617-667-9711
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:SHAPIRO 5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-8807
Practice Address - Fax:617-667-9711
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2012-10-30
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Provider Licenses
StateLicense IDTaxonomies
MARN280482363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health