NPI 1104171321 · live from the CMS NPI Registry
Jennifer Rose Bertolon, CPNP, RN
Nurse Practitioner, Pediatrics in Beverly, MA. National Provider Identifier 1104171321, active.
NPI record
| NPI | 1104171321 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 245 Dodge St, Beverly, MA 01915 |
| Practice phone | 978-618-0239 |
| Enumerated | July 14, 2012 |
| Last updated | July 14, 2012 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse, Pediatrics | 163WP0200X | RN2269678 (MA) |
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 20121422 (MA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.