Provider Demographics
NPI:1487477436
Name:GILLIGAN, JENNIFER DAWN (AGNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MAIN ST STE 15
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984-1451
Mailing Address - Country:US
Mailing Address - Phone:978-239-0222
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST STE 15
Practice Address - Street 2:
Practice Address - City:WENHAM
Practice Address - State:MA
Practice Address - Zip Code:01984-1451
Practice Address - Country:US
Practice Address - Phone:978-239-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN232749363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health