Healthcare Provider Details

I. General information

NPI: 1861739500
Provider Name (Legal Business Name): JENIFER K CANFIELD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CLARA BARTON ST
DANSVILLE NY
14437-9527
US

IV. Provider business mailing address

3603 BROWN HILL RD
COHOCTON NY
14826-9607
US

V. Phone/Fax

Practice location:
  • Phone: 585-519-8829
  • Fax:
Mailing address:
  • Phone: 585-519-8829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number704268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: