Provider Demographics
NPI:1306866793
Name:STOCKBRIDGE, JENNIFER L (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:STOCKBRIDGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:H
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 CAMBRIDGE ST # 530
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3108
Mailing Address - Country:US
Mailing Address - Phone:617-726-8707
Mailing Address - Fax:
Practice Address - Street 1:275 CAMBRIDGE ST # 530
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3108
Practice Address - Country:US
Practice Address - Phone:617-726-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0700673Medicaid
MANP4795Medicare ID - Type Unspecified
MAQ27205Medicare UPIN