Provider Demographics
NPI:1326792714
Name:DUFFY, JENE E (AS,RN,MCC)
Entity Type:Individual
Prefix:
First Name:JENE
Middle Name:E
Last Name:DUFFY
Suffix:
Gender:F
Credentials:AS,RN,MCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 STARLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-8502
Mailing Address - Country:US
Mailing Address - Phone:302-448-9109
Mailing Address - Fax:
Practice Address - Street 1:126 STARLIGHT DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-8502
Practice Address - Country:US
Practice Address - Phone:302-344-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0011308164W00000X
DEL1-0072586163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2019702798OtherHRSA, PRIVATE INSURANCE