Provider Demographics
NPI:1992254320
Name:SALANDER, JENNIFER RENAY (NP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENAY
Last Name:SALANDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5567
Mailing Address - Country:US
Mailing Address - Phone:508-583-3005
Mailing Address - Fax:
Practice Address - Street 1:280 TINKHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01129-1935
Practice Address - Country:US
Practice Address - Phone:413-731-4997
Practice Address - Fax:413-783-0675
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704292307363LP0200X, 363LP2300X
MARN2311003363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care