Provider Demographics
NPI:1548301922
Name:FEMINO, JENNIFER LYNNE EYSIE (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE EYSIE
Last Name:FEMINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:EYSIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-7308
Mailing Address - Country:US
Mailing Address - Phone:978-825-1130
Mailing Address - Fax:978-745-9857
Practice Address - Street 1:47 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-7308
Practice Address - Country:US
Practice Address - Phone:978-825-1130
Practice Address - Fax:978-745-9857
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA254783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily