MEDICARE: NICOLE JENNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	312448	NY

General Provider Information

NPI Number	:	1124369327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE JENNEY

Provider Business Mailing Address
First Line	:	4087 MCGRAW NORTH RD
Second Line	:
City	:	MC GRAW
State	:	NY
Zip	:	13101-9563
Country	:	US
Telephone Number	:	607-345-1635
Fax Number	:

Provider Business Practice Location Address
First Line	:	4087 MCGRAW NORTH RD
Second Line	:
City	:	MC GRAW
State	:	NY
Zip	:	13101-9563
Country	:	US
Telephone Number	:	607-345-1635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2013
Last Update Date	:	03/13/2013

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Directions to “ NICOLE JENNEY ” Practice Location

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