Provider Demographics
NPI:1932538238
Name:HUNTZ, JACQUELYNN (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:
Last Name:HUNTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JACQUELYNN
Other - Middle Name:
Other - Last Name:BARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:206 S ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-2398
Mailing Address - Country:US
Mailing Address - Phone:716-847-0315
Mailing Address - Fax:716-847-2715
Practice Address - Street 1:206 S ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-2398
Practice Address - Country:US
Practice Address - Phone:716-847-0315
Practice Address - Fax:716-847-2715
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY677752163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse