Provider Demographics
NPI:1790432136
Name:JENNIFER SHARE MIDWIFERY AND TESS INTERLICCHIA NURSE PRACTITIONER IN F
Entity Type:Organization
Organization Name:JENNIFER SHARE MIDWIFERY AND TESS INTERLICCHIA NURSE PRACTITIONER IN F
Other - Org Name:ROOT TO RISE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHARE
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:607-738-7218
Mailing Address - Street 1:21 E MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2650
Mailing Address - Country:US
Mailing Address - Phone:607-377-6832
Mailing Address - Fax:607-654-4122
Practice Address - Street 1:21 E MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2650
Practice Address - Country:US
Practice Address - Phone:607-377-6832
Practice Address - Fax:607-654-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty