MEDICARE: JENNY AMANDA BARNUM NP

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	363LA2200X	Adult Health Nurse Practitioner	F305388	NY
2	363LA2200X	Adult Health Nurse Practitioner	305388	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F305388	OTHER		LICENSE

General Provider Information

NPI Number	:	1316253768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY AMANDA BARNUM NP

Provider Business Mailing Address
First Line	:	11 SOUTHERN HILLS CIR
Second Line	:
City	:	HENRIETTA
State	:	NY
Zip	:	14467-9709
Country	:	US
Telephone Number	:	585-520-8911
Fax Number	:	585-548-0107

Provider Business Practice Location Address
First Line	:	5232 WITZ DR
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212
Country	:	US
Telephone Number	:	888-562-5442
Fax Number	:

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

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	08/09/2021

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