Provider Demographics
NPI:1649402553
Name:DEIANA, JENNIFER LYNN (CPNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:DEIANA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1207
Mailing Address - Country:US
Mailing Address - Phone:508-561-7390
Mailing Address - Fax:
Practice Address - Street 1:132 CENTRAL ST
Practice Address - Street 2:STE 116
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2433
Practice Address - Country:US
Practice Address - Phone:508-543-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN278001363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics