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General NPI Number Information
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NPI Number | 1407261555
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Entity Type | Individual
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Provider Name | JENNA PODLUCKY FNP
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Gender | Female
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 601 ELMWOOD AVE WILMOT CANCER CENTER
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City | ROCHESTER
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State | NY
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Zip | 14642-0001
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Country | US
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Telephone | 585-275-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 85 ALLEN ST APT 402
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City | ROCHESTER
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State | NY
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Zip | 14608-1811
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Country | US
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Telephone | 716-807-6337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 338842
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F338842-1
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License Number State | NY
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