Provider Demographics
NPI:1447719950
Name:JENNER, MARGARET (LPN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:JENNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-0423
Mailing Address - Country:US
Mailing Address - Phone:315-531-9102
Mailing Address - Fax:
Practice Address - Street 1:60 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT BYRON
Practice Address - State:NY
Practice Address - Zip Code:13140-1314
Practice Address - Country:US
Practice Address - Phone:315-776-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230969164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse