| Doctor Name: | JENNIFER TRINH PHAN |
| NPI Number: | 1538443460 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP-C |
| License Number: | RN2264825 |
| Business Practice Address: | 266 Main St Ste 4 Medfield, MA - 020522018 |
| Business Phone Number: | 5083598141 |
| Business Fax Number: | 5083598005 |
| Mailing Address: | 266 Main St Ste 4, P.o. Box 469 MEDFIELD |
| State: | MA |
| Postal Code: | 020522018 |
| Phone Number: | 5083598141 |
| Fax Number: | 5083598005 |
| NPI Enumeration Date: | 10/11/2011 |
| NPI Last Update Date: | 10/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | RN2264825 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |