Provider Demographics
NPI:1710132626
Name:CERNY, JENNIFER LUZIA (MS, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LUZIA
Last Name:CERNY
Suffix:
Gender:F
Credentials:MS, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 MUDDY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-6916
Mailing Address - Country:US
Mailing Address - Phone:336-764-1109
Mailing Address - Fax:
Practice Address - Street 1:3000 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4002
Practice Address - Country:US
Practice Address - Phone:336-768-2980
Practice Address - Fax:336-765-6599
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900459363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health