Provider Demographics
NPI:1679765465
Name:OPPENHEIM, JILLIAN LEIGH (APRN BC FNP)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:LEIGH
Last Name:OPPENHEIM
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Gender:F
Credentials:APRN BC FNP
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Mailing Address - Street 1:38R ENON STREET
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-927-7717
Mailing Address - Fax:978-927-4598
Practice Address - Street 1:55 HIGHLAND AVE
Practice Address - Street 2:STE. 101
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2185
Practice Address - Country:US
Practice Address - Phone:978-740-2300
Practice Address - Fax:978-744-3993
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2013-12-13
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Provider Licenses
StateLicense IDTaxonomies
MA267909363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0715522Medicaid
MA000265701Medicare UPIN