Provider Demographics
NPI:1417013525
Name:FOX, JENNELL KAREN (NURSE)
Entity Type:Individual
Prefix:
First Name:JENNELL
Middle Name:KAREN
Last Name:FOX
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3657 S TOWNLINE RD LOT 23
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-9760
Mailing Address - Country:US
Mailing Address - Phone:315-502-4037
Mailing Address - Fax:315-502-4037
Practice Address - Street 1:743 HAILEY DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-4053
Practice Address - Country:US
Practice Address - Phone:585-671-8144
Practice Address - Fax:585-671-8144
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267616-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse