Healthcare Provider Details

I. General information

NPI: 1245843408
Provider Name (Legal Business Name): JENNIFER L HENNESSY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 COMPUTER DR W
ALBANY NY
12205-1679
US

IV. Provider business mailing address

24 COMPUTER DR W
ALBANY NY
12205-1679
US

V. Phone/Fax

Practice location:
  • Phone: 518-689-7548
  • Fax: 518-489-9431
Mailing address:
  • Phone: 518-689-7548
  • Fax: 518-489-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number346072
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: