Provider Demographics
NPI:1396714499
Name:JUMPER, LYNN ELLEN (ANP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ELLEN
Last Name:JUMPER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-4080
Mailing Address - Country:US
Mailing Address - Phone:781-620-4888
Mailing Address - Fax:781-245-2602
Practice Address - Street 1:888 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-4080
Practice Address - Country:US
Practice Address - Phone:781-620-4888
Practice Address - Fax:781-245-2602
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA170760NP207RA0000X
MARN170760363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0354261Medicaid
MAM17510OtherBC - GROUP #
MA9700480Medicaid
MA500016495OtherMEDICARE RR
MANP1749OtherBC
MAM20832Medicare ID - Type UnspecifiedGROUP #
MA9700480Medicaid
MAM17510OtherBC - GROUP #