Provider Demographics
NPI:1295286706
Name:ENNIS, JAMES (NP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ENNIS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CUMMINGS CENTER, SUITE 107W
Mailing Address - Street 2:LAHEY HEALTH PRIMARY CARE, BEVERLY
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-927-1859
Mailing Address - Fax:
Practice Address - Street 1:900 CUMMINGS CENTER, SUITE 107W
Practice Address - Street 2:LAHEY HEALTH PRIMARY CARE, BEVERLY
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-927-1859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2289482364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health