Provider Demographics
NPI:1750704466
Name:KUMIN, JENNIFER L (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:KUMIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-742-7338
Mailing Address - Fax:603-740-9528
Practice Address - Street 1:15 OLD ROLLINSFORD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2868
Practice Address - Country:US
Practice Address - Phone:603-742-7338
Practice Address - Fax:603-740-9528
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH069192-23363LP2300X
MECNP141008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1750704466Medicaid
NH3096141Medicaid
NHT400126364Medicare PIN