=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598545683
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE CARMODY DNP. MBA, RN, FAAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2023
-----------------------------------------------------
Last Update Date | 10/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 E 59TH ST FL 16
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-880-5620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 E 59TH ST FL 16
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10022-1713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-880-5620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Registered Nurse
-----------------------------------------------------
License Number | 728963-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------