Provider Demographics
NPI:1104048313
Name:PINARD, JENNIFER A (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:PINARD
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:P O BOX 912
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-0912
Mailing Address - Country:US
Mailing Address - Phone:603-569-7588
Mailing Address - Fax:603-569-7588
Practice Address - Street 1:240 SOUTH MAIN STREET
Practice Address - Street 2:SUITE J
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4411
Practice Address - Country:US
Practice Address - Phone:603-569-7588
Practice Address - Fax:603-569-7589
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH0524282303163W00000X
NH052428-23363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHQ26466Medicare UPIN
NHNP4779Medicare ID - Type Unspecified