Provider Demographics
NPI:1205436417
Name:ALEJANDRO, JENNIFER LYNN (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:ALEJANDRO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8048 BATAVIA BYRON RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9750
Mailing Address - Country:US
Mailing Address - Phone:585-300-7371
Mailing Address - Fax:
Practice Address - Street 1:3384 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:NY
Practice Address - Zip Code:14005-9629
Practice Address - Country:US
Practice Address - Phone:585-599-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310049363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health