Individual
MS. JENNIFER LYNN SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP-BC
Contact information
Practice address
165 CAMBRIDGE ST, SUITE 810, BOSTON, MA 02114-2783
(617) 726-2000
Mailing address
PO BOX 232410, SAN DIEGO, CA 92193-2410
(858) 249-6749
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP95004457
CA
363LA2100X
Acute Care Nurse Practitioner
RN219976
MA
Other
Enumeration date
12/12/2012
Last updated
01/16/2018
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