Provider Demographics
NPI:1417247180
Name:FERRIS, JEANNIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:
Last Name:FERRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 AUGUSTUS ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4257
Mailing Address - Country:US
Mailing Address - Phone:315-237-7174
Mailing Address - Fax:
Practice Address - Street 1:38 AUGUSTUS ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4257
Practice Address - Country:US
Practice Address - Phone:315-237-7174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274541-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse