Provider Demographics
NPI:1245209824
Name:CAVAGE, JENNIFER H (GNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:H
Last Name:CAVAGE
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GNP
Mailing Address - Street 1:300 MERIDIAN CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3981
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 MERIDIAN CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3981
Practice Address - Country:US
Practice Address - Phone:585-463-3148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH073601-23363LG0600X
OR200450070NP363LG0600X
RIAPRN01533363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022627Medicaid
120703Medicare PIN
120705Medicare PIN
OR022627Medicaid