Provider Demographics
NPI:1619302619
Name:DOANE, JENNIE MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:MARIE
Last Name:DOANE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:JENNIE
Other - Middle Name:MARIE
Other - Last Name:PIETRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:236 BELLE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-1938
Mailing Address - Country:US
Mailing Address - Phone:216-392-2221
Mailing Address - Fax:
Practice Address - Street 1:236 BELLE AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-1938
Practice Address - Country:US
Practice Address - Phone:216-392-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306581363LA2200X
NYF340918363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology