Healthcare Provider Details

I. General information

NPI: 1770684045
Provider Name (Legal Business Name): JENNIFER LEIGH GEBHARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HOWELL ST
CANANDAIGUA NY
14424-1215
US

IV. Provider business mailing address

209 HOWELL ST
CANANDAIGUA NY
14424-1215
US

V. Phone/Fax

Practice location:
  • Phone: 631-748-6746
  • Fax: 866-840-4621
Mailing address:
  • Phone: 631-748-6746
  • Fax: 866-840-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF300575-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: