Provider Demographics
NPI:1073091310
Name:NEMETH, JENELLE DONZELLI (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:DONZELLI
Last Name:NEMETH
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:JENELLE
Other - Middle Name:BROOKE
Other - Last Name:NEMETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN, IBCLC
Mailing Address - Street 1:34 FULLER DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:NY
Mailing Address - Zip Code:12822-2321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 FULLER DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:NY
Practice Address - Zip Code:12822-2321
Practice Address - Country:US
Practice Address - Phone:704-746-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-86564163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY615812OtherRN