Provider Demographics
NPI:1821760372
Name:CORMIER, JENNIFER MARJORIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARJORIE
Last Name:CORMIER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-3113
Mailing Address - Country:US
Mailing Address - Phone:508-353-6523
Mailing Address - Fax:
Practice Address - Street 1:874 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6232
Practice Address - Country:US
Practice Address - Phone:508-992-6553
Practice Address - Fax:508-997-2498
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA234911163WE0003X
MARN234911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency