Healthcare Provider Details

I. General information

NPI: 1992783153
Provider Name (Legal Business Name): JENNIFER METZGAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 DANBY RD
ITHACA NY
14850-7000
US

IV. Provider business mailing address

500 LOCKE RD
GROTON NY
13073-9494
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-3177
  • Fax:
Mailing address:
  • Phone: 607-898-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332604
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: