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General NPI Number Information
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NPI Number | 1609356526
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Entity Type | Individual
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Provider Name | JENNIFER UPDYKE RDMS RVT RDCS
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Gender | Female
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 12 MARTIN ST
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City | WELLSVILLE
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State | NY
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Zip | 14895
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Country | US
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Telephone | 585-593-6069
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Fax | 585-219-5735
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Provider Business Mailing Address
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Address Line | PO BOX 236
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City | ANDOVER
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State | NY
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Zip | 14806-0236
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Country | US
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Telephone |
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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 | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number |
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License Number State |
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