Jean Elizabeth Mack-Fogg
Nurse Practitioner - Pediatrics
601 Elmwood Ave
Rochester
, New York 14642
Jean Elizabeth Mack-Fogg
Nurse Practitioner - Pediatrics
601 Elmwood Ave
Rochester
, New York 14642
(585) 275-7787
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About
Features
Specialties
- Nurse Practitioner - Pediatrics
Languages spoken
- English
Location
First Address
- Jean Elizabeth Mack-Fogg
- 601 Elmwood Ave Box 635
- Rochester, NY
- Zip : 14642-0001
- Phone : (585) 275-7787
Second Address
- Jean Elizabeth Mack-Fogg
- 601 Elmwood Ave
- Rochester, NY
- Zip : 14642
- Phone : (585) 275-7787
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Is Jean Elizabeth Mack-Fogg a sole practitioner?
Is Jean Elizabeth Mack-Fogg accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP0200X | Nurse Practitioner - Pediatrics | 7475 | CT |
| N | 363LP0200X | Nurse Practitioner - Pediatrics | F380190 | NY |
National Provider Identifier
| NPI | 1023048600 |
|---|---|
| Provider Name | Jean Elizabeth Mack-Fogg |
| First Address | Rochester, NY 14642-0001 |
| Second Address | Rochester, NY 14642 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/07/2006 |
| Last Update Date | 24/07/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 02299521 | (05) | NY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.