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General NPI Number Information
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NPI Number | 1881575959
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Entity Type | Individual
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Provider Name | JENNIFER HOLTKAMP
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Gender | Female
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 620 MADISON ST STE 120
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City | SYRACUSE
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State | NY
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Zip | 13210-2338
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Country | US
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Telephone | 315-426-3600
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Fax | 315-426-3605
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Provider Business Mailing Address
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Address Line | 101 CLINTON AVE APT 4
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City | CORTLAND
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State | NY
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Zip | 13045-1359
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Country | US
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Telephone | 607-233-3344
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 605897
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License Number State | NY
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