Provider Demographics
NPI:1912931742
Name:OHERN, JENNIFER MILLER (BSN MSN APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MILLER
Last Name:OHERN
Suffix:
Gender:F
Credentials:BSN MSN APRN
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:ELAINE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:382 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515
Mailing Address - Country:US
Mailing Address - Phone:203-397-1772
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAPEL STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-789-3499
Practice Address - Fax:203-789-4110
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT070399163W00000X
CT002815363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P92179Medicare UPIN