Provider Demographics
NPI:1093999153
Name:PARODY, JENNIFER L (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:PARODY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:DELOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:16873 COUNTY RTE 53
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:NY
Mailing Address - Zip Code:13634
Mailing Address - Country:US
Mailing Address - Phone:315-489-6208
Mailing Address - Fax:
Practice Address - Street 1:16873 COUNTY RT. 53
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:NY
Practice Address - Zip Code:13634
Practice Address - Country:US
Practice Address - Phone:315-489-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266867-1164W00000X
104100000X
NY266867164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02569919Medicaid