Provider Demographics
NPI:1821339573
Name:SHARE, JENNIFER L (CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SHARE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY552045-1163WM0102X
NY176B00000X
NY001837367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Single Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Single Specialty