Healthcare Provider Details

I. General information

NPI: 1952382566
Provider Name (Legal Business Name): JEAN P HOWARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352 RT 26
ENDICOTT NY
13760-6418
US

IV. Provider business mailing address

346 GRAND AVE
JOHNSON CITY NY
13790-2580
US

V. Phone/Fax

Practice location:
  • Phone: 607-862-4325
  • Fax: 607-862-9006
Mailing address:
  • Phone: 607-729-8156
  • Fax: 607-729-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number331439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: