Provider Demographics
NPI:1962403238
Name:CHAREST, JEANNE D (APRN)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:D
Last Name:CHAREST
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 1:133 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-2006
Mailing Address - Country:US
Mailing Address - Phone:603-752-2040
Mailing Address - Fax:603-752-7797
Practice Address - Street 1:133 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-2006
Practice Address - Country:US
Practice Address - Phone:603-752-2040
Practice Address - Fax:603-752-7797
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0139452302363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3071895Medicaid
NH0139452302OtherSTATE LICENSE #
020350051OtherFEDERAL TAX ID
NH16009OtherCIGNA HEALTHCARE
NH2308433YPNH01OtherANTHEM BC/BS
NH30005542Medicaid
5830418OtherAETNA
5830418OtherAETNA
020350051OtherFEDERAL TAX ID
MC0050207OtherFEDERAL DEA #