Provider Demographics
NPI:1659628865
Name:DEEKENS, JENNIFER GROGAN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GROGAN
Last Name:DEEKENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:2570 ROUTE 9W STE 10
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1370
Mailing Address - Country:US
Mailing Address - Phone:845-220-3100
Mailing Address - Fax:845-534-2940
Practice Address - Street 1:24 OLD FIREHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589
Practice Address - Country:US
Practice Address - Phone:845-393-6015
Practice Address - Fax:845-393-6016
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2018-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC5007361363LF0000X
NY337181363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily