Provider Demographics
NPI:1457107120
Name:FERNSTROM, JENIFER ERIN (FNP)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:ERIN
Last Name:FERNSTROM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:
Other - Last Name:COUTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:594 GREAT RD STE 102A
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6810
Mailing Address - Country:US
Mailing Address - Phone:401-768-3400
Mailing Address - Fax:401-768-3402
Practice Address - Street 1:594 GREAT RD STE 102A
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6810
Practice Address - Country:US
Practice Address - Phone:401-768-3400
Practice Address - Fax:401-768-3402
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN04029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily