Provider Demographics
NPI:1871770511
Name:UNDERWOOD, JOELLE (FNP)
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1214
Mailing Address - Country:US
Mailing Address - Phone:607-865-5800
Mailing Address - Fax:
Practice Address - Street 1:6 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1214
Practice Address - Country:US
Practice Address - Phone:607-865-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335119363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily