Provider Demographics
NPI:1376887778
Name:KADEL, JENNIFER DIANE (ACNP)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:DIANE
Last Name:KADEL
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1336
Mailing Address - Country:US
Mailing Address - Phone:516-526-8798
Mailing Address - Fax:
Practice Address - Street 1:64 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1336
Practice Address - Country:US
Practice Address - Phone:516-526-8798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430671363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care