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General NPI Number Information
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NPI Number | 1659040079
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Entity Type | Individual
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Provider Name | JENNIFER LYNN HOLMBERG FNP
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Gender | Female
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Dates
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Enumeration Date | 09/09/2021
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 400 PLAZA DRIVE SUITE C
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City | VESTAL
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State | NY
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Zip | 13850
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Country | US
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Telephone | 607-237-0065
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Fax |
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Provider Business Mailing Address
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Address Line | 400 PLAZA DRIVE SUITE C
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City | VESTAL
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State | NY
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Zip | 13850
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Country | US
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Telephone | 607-237-0065
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Fax | 888-832-4418
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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 | 348217
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License Number State | NY
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