Provider Demographics
NPI:1679557987
Name:AMON, JENNIFER CATHERINE (CPNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:AMON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CATHERINE
Other - Last Name:OSTRANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:143 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1683
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300264208000000X, 2080A0000X, 363LP0200X
DCRN1008418363LP0200X
WAAP60023099363LP0200X
MARN2299302363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110102976AMedicaid
MA1679557987OtherNEIGHBORHOOD HEALTH PLAN
1679557987OtherFALLON
04-2297845OtherMULTI-PLAN
04-2297845OtherTRICARE
MANP8062OtherBCBSMA
MA1679557987OtherNEIGHBORHOOD HEALTH PLAN
MA110102976AMedicaid