Provider Demographics
NPI:1629776026
Name:HATCH, JENIFER LEE
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:LEE
Last Name:HATCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 PORTLAND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1713
Mailing Address - Country:US
Mailing Address - Phone:508-474-9247
Mailing Address - Fax:
Practice Address - Street 1:175 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1717
Practice Address - Country:US
Practice Address - Phone:508-474-9247
Practice Address - Fax:857-327-9178
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN285380363LF0000X, 163WC1500X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health