Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 335773 | NY |
NPI | 1003054263 |
---|---|
Provider Name | Ms. Jennifer Lynn Iovinelli |
First Address | Schenectady, NY 12304 |
Second Address | Schenectady, NY 12304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2009 |
Last Update Date | 22/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03126749 | (05) | NY |