Provider Demographics
NPI:1790980746
Name:SHUART, JENNIFER M (PMHNP-BC, APRN)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:M
Last Name:SHUART
Suffix:
Gender:F
Credentials:PMHNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131B MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-2428
Mailing Address - Country:US
Mailing Address - Phone:617-283-3305
Mailing Address - Fax:603-218-6990
Practice Address - Street 1:131B MAIN ST
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042-2428
Practice Address - Country:US
Practice Address - Phone:617-283-3305
Practice Address - Fax:603-218-6990
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1149691041C0700X
NH078416-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110027964AMedicaid
NH3114987Medicaid