Provider Demographics
NPI:1255340469
Name:GANEM, JENNIFER ANNE (MS, APRN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNE
Last Name:GANEM
Suffix:
Gender:F
Credentials:MS, APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GANEM
Other - Last Name:LAFOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, APRN
Mailing Address - Street 1:50 NASHUA RD STE 208
Mailing Address - Street 2:LONDONDERRY SQUARE
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3438
Mailing Address - Country:US
Mailing Address - Phone:603-432-3399
Mailing Address - Fax:603-432-3396
Practice Address - Street 1:50 NASHUA RD STE 208
Practice Address - Street 2:LONDONDERRY SQUARE
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3438
Practice Address - Country:US
Practice Address - Phone:603-432-3399
Practice Address - Fax:603-432-3396
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0374162308363LP0808X
NH037416-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP0925Medicare UPIN