Provider Demographics
NPI:1881112837
Name:WINIARCZYK-NALLE, JENNIFER RENE (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RENE
Last Name:WINIARCZYK-NALLE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:RENE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5655 STEVENS DR S
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9535
Mailing Address - Country:US
Mailing Address - Phone:315-420-2035
Mailing Address - Fax:
Practice Address - Street 1:115 CREEK CIR
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-1369
Practice Address - Country:US
Practice Address - Phone:315-413-4536
Practice Address - Fax:315-492-1672
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402255363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health