Provider Demographics
NPI:1437559614
Name:HADDAD, JENNIFER VITTI (BSN, RN, MSN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:VITTI
Last Name:HADDAD
Suffix:
Gender:F
Credentials:BSN, RN, MSN, CPNP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:VITTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN, MSN, CPNP
Mailing Address - Street 1:320 BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3988
Mailing Address - Country:US
Mailing Address - Phone:508-460-9670
Mailing Address - Fax:
Practice Address - Street 1:320 BOLTON ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3988
Practice Address - Country:US
Practice Address - Phone:508-460-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270244363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics