Provider Demographics
NPI:1851841894
Name:MCNAUGHTON, JENNA LEE (RN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEE
Last Name:MCNAUGHTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 PALISADE AVE
Mailing Address - Street 2:#2
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-1125
Mailing Address - Country:US
Mailing Address - Phone:941-807-2884
Mailing Address - Fax:
Practice Address - Street 1:550 BROADWAY
Practice Address - Street 2:608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3917
Practice Address - Country:US
Practice Address - Phone:888-571-8629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721743163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse