=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821107517
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY JENSEN HILL MSNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1930 PRE EMPTION RD
-----------------------------------------------------
City | PENN YAN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14527-9641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-536-7725
-----------------------------------------------------
Fax | 315-536-4107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1930 PRE EMPTION RD
-----------------------------------------------------
City | PENN YAN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14527-9549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-536-0008
-----------------------------------------------------
Fax | 315-536-4107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | F301653-A
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------