Provider Demographics
NPI:1992215438
Name:BELLANO, JENNA (ATS)
Entity Type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:
Last Name:BELLANO
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 RALSTON ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3667
Mailing Address - Country:US
Mailing Address - Phone:203-456-0420
Mailing Address - Fax:
Practice Address - Street 1:81 RALSTON ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3667
Practice Address - Country:US
Practice Address - Phone:203-456-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTW171481993OtherAETNA