Provider Demographics
NPI:1356756647
Name:SMITH, JENNY L (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 NASHUA ST
Mailing Address - Street 2:ST. JOSEPH HOSPITAL FAMILY PRACTICE
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4915
Mailing Address - Country:US
Mailing Address - Phone:603-673-3014
Mailing Address - Fax:
Practice Address - Street 1:444 NASHUA ST
Practice Address - Street 2:ST. JOSEPH HOSPITAL FAMILY PRACTICE
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4915
Practice Address - Country:US
Practice Address - Phone:603-673-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH05929521163W00000X
NH059259-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse