Jenaye Karin Broe, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Fayetteville, NY
NPI 1154817633 · NPPES record last updated Jul 8, 2018
Key facts
- NPI
- 1154817633
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- F343229-1 (NY)
- Practice address
- 4000 Medical Center Dr Ste 110
Fayetteville, NY 13066-6631 - Phone
- (315) 663-0100
- NPI assigned
- Jul 8, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180829002954 | NY | Practitioner - Nurse Practitioner | 7315297199 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F343229-1 | NY | MD | Family Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F343229-1 | NY | Yes |
Addresses
Primary practice location
4000 Medical Center Dr Ste 110
Fayetteville, NY 13066-6631
Mailing address
113 Red Barn Cir
Liverpool, NY 13088-4988
Phone (607) 287-2461
Other providers in Fayetteville, NY
- Carole S. Bragdon
- Denis F Branson
- Susan Hartman Brenizer
- Erica L Brier-Kennedy
- Mark Briggs
- Dana Rae Brompton
- Vadjista Broumand
- Edith P Brown
- Joseph Bulone
- Chanele M Burgun
All providers in Fayetteville, NY · Family Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.