Provider Demographics
NPI:1134415086
Name:KOLCHINSKY, JENNIFER ROSE (ANP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:KOLCHINSKY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ROSE
Other - Last Name:WERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:370 FAUNCE CORNER ROAD
Mailing Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC.
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1271
Mailing Address - Country:US
Mailing Address - Phone:508-985-2000
Mailing Address - Fax:508-985-2001
Practice Address - Street 1:480 HAWTHORN STREET
Practice Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC.
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3713
Practice Address - Country:US
Practice Address - Phone:508-993-3555
Practice Address - Fax:508-990-1176
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN26946363LP2300X
MARN269468363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner