Provider Demographics
NPI:1114348455
Name:MASTIN, JENNIFER (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MASTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:NY
Mailing Address - Zip Code:14568-9336
Mailing Address - Country:US
Mailing Address - Phone:585-278-8136
Mailing Address - Fax:
Practice Address - Street 1:3757 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:WALWORTH
Practice Address - State:NY
Practice Address - Zip Code:14568-9336
Practice Address - Country:US
Practice Address - Phone:585-278-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY55341-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse