Healthcare Provider Details

I. General information

NPI: 1639617046
Provider Name (Legal Business Name): JENNIFER HECTOR-NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ASHLEY AVE
MIDDLETOWN NY
10940-1912
US

IV. Provider business mailing address

PO BOX 407
YOUNGSVILLE NY
12791-0407
US

V. Phone/Fax

Practice location:
  • Phone: 845-707-1646
  • Fax:
Mailing address:
  • Phone: 845-482-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number563340
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number563340
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number563340
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number563340
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF311182-01
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF311182-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: