Provider Demographics
NPI:1902267727
Name:ISAAC JEFFERSON, JAMIE TENNEILL (CNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:TENNEILL
Last Name:ISAAC JEFFERSON
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:BIDMC, DEPARTMENT OF OB/GYN, SHAPIRO 8TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-3736
Mailing Address - Fax:617-667-7493
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:BIDMC, DEPARTMENT OF OB/GYN, SHAPIRO 8TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3736
Practice Address - Fax:617-667-7493
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2292515363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health