Provider Demographics
NPI:1811005648
Name:JEFFRIES, JENNIFER FAULKNER (MD MPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FAULKNER
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 CILLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-4500
Mailing Address - Country:US
Mailing Address - Phone:603-606-6977
Mailing Address - Fax:603-606-6983
Practice Address - Street 1:345 CILLEY ROAD
Practice Address - Street 2:JEFFRIES FAMILY MEDICINE PLLC
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-4500
Practice Address - Country:US
Practice Address - Phone:603-606-6977
Practice Address - Fax:603-606-6983
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH10123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010896Medicaid
RE4754Medicare ID - Type Unspecified
NH30010896Medicaid
G65371Medicare UPIN