Provider Demographics
NPI:1104045848
Name:REID, JENNIFER ELSETA (GNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELSETA
Last Name:REID
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ELSETA
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP
Mailing Address - Street 1:396 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4329
Mailing Address - Country:US
Mailing Address - Phone:585-889-5582
Mailing Address - Fax:
Practice Address - Street 1:396 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-4329
Practice Address - Country:US
Practice Address - Phone:585-889-5582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340665-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology