Provider Demographics
NPI:1649770009
Name:THRASHER, JENNIFER DAWNETTE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWNETTE
Last Name:THRASHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 STOUT CT APT C
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2964
Mailing Address - Country:US
Mailing Address - Phone:845-702-0658
Mailing Address - Fax:
Practice Address - Street 1:17 STOUT CT
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2963
Practice Address - Country:US
Practice Address - Phone:845-702-0658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342219341204E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide