Provider Demographics
NPI:1326355793
Name:REAGAN, JENNIFER COLLEEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:COLLEEN
Last Name:REAGAN
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 1:167 PITTSFORD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-3161
Mailing Address - Country:US
Mailing Address - Phone:585-254-2102
Mailing Address - Fax:
Practice Address - Street 1:167 PITTSFORD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-3161
Practice Address - Country:US
Practice Address - Phone:585-254-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630696-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse