Provider Demographics
NPI:1003115528
Name:ZETHNER, JENNIFER ANNE (RN,MS,PNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:ZETHNER
Suffix:
Gender:F
Credentials:RN,MS,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1036
Mailing Address - Country:US
Mailing Address - Phone:631-427-3001
Mailing Address - Fax:
Practice Address - Street 1:220 FORT SALONGA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3900
Practice Address - Country:US
Practice Address - Phone:631-262-8505
Practice Address - Fax:631-754-2909
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381350-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics