Provider Demographics
NPI:1760078679
Name:BARTLETT, JENNA ROSE (CNM)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ROSE
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:ROSE
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1150 RESERVOIR AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6032
Mailing Address - Country:US
Mailing Address - Phone:401-223-2828
Mailing Address - Fax:401-223-2825
Practice Address - Street 1:1150 RESERVOIR AVE STE 300
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6032
Practice Address - Country:US
Practice Address - Phone:401-223-2828
Practice Address - Fax:401-223-2825
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICNM00215367A00000X
NC24625A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife