Provider Demographics
NPI:1821726043
Name:FORDHAM, JAIME LYNN (WHNP- BC)
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:LYNN
Last Name:FORDHAM
Suffix:
Gender:F
Credentials:WHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 668
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-2691
Mailing Address - Fax:
Practice Address - Street 1:125 LATTIMORE RD STE 150
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4156
Practice Address - Country:US
Practice Address - Phone:585-275-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421350207VG0400X
NYF-421350-01207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology