Jean M Dennis

Individual provider Active NPI Licensed Practical Nurse · Dryden, NY

NPI 1902005259 · NPPES record last updated Jul 17, 2007

Key facts

NPI
1902005259
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
246496-1 (NY)
Practice address
155 Dryden Harford Rd
Dryden, NY 13053-9773
Phone
(607) 844-4861
NPI assigned
Jul 17, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
246496-1NYMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 246496-1 NY Yes

Addresses

Primary practice location

155 Dryden Harford Rd
Dryden, NY 13053-9773

Mailing address

155 Dryden Harford Rd
Dryden, NY 13053-9773
Phone (607) 844-4861

Other identifiers

IdentifierTypeStateIssuer
02641312MedicaidNY

Other providers in Dryden, NY

All providers in Dryden, NY · Licensed Practical Nurse in New York

Sources for this page

Verify at the official NPI Registry.