Provider Demographics
NPI:1801137351
Name:ATTIYEH, JENNA (MS, RN, APRN, BC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:ATTIYEH
Suffix:
Gender:F
Credentials:MS, RN, APRN, BC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:NIKOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RN, APRN, BC
Mailing Address - Street 1:1 GUSTAVE L LEVY PL
Mailing Address - Street 2:BOX 1023
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6504
Mailing Address - Country:US
Mailing Address - Phone:212-241-4325
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:BOX 1023
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:212-241-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY619019-1163W00000X
NYF430888-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse