Provider Demographics
NPI:1134679673
Name:MISIASZEK, JENNIFER (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:MISIASZEK
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 1:121 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ORISKANY FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13425-3857
Mailing Address - Country:US
Mailing Address - Phone:315-570-5775
Mailing Address - Fax:
Practice Address - Street 1:121 BROAD ST
Practice Address - Street 2:
Practice Address - City:ORISKANY FALLS
Practice Address - State:NY
Practice Address - Zip Code:13425-3857
Practice Address - Country:US
Practice Address - Phone:315-570-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646944-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool