Provider Demographics
NPI:1093316093
Name:STILLMAN, JENNY LYNN (APRN)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:STILLMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:LYNN
Other - Last Name:POLLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-C
Mailing Address - Street 1:445 CYPRESS ST STE 8
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3600
Mailing Address - Country:US
Mailing Address - Phone:603-668-4079
Mailing Address - Fax:
Practice Address - Street 1:92 CENTER RD
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:NH
Practice Address - Zip Code:03221-3600
Practice Address - Country:US
Practice Address - Phone:603-680-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH063382-23363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily