Provider Demographics
NPI:1548222383
Name:DOHRN, JENNIFER ELLEN (CNM)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELLEN
Last Name:DOHRN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 W BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4015
Mailing Address - Country:US
Mailing Address - Phone:718-716-2229
Mailing Address - Fax:718-228-7471
Practice Address - Street 1:70 W BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4016
Practice Address - Country:US
Practice Address - Phone:718-716-2229
Practice Address - Fax:718-228-7471
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000390367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000390OtherLICENSE#