Basic Information
| Provider Information | |||||||||
| NPI: | 1598331266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLE | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 LEISURE LN | ||||||||
| Address2: | |||||||||
| City: | FREEVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130689523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075925157 | ||||||||
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| Practice Location | |||||||||
| Address1: | 740 S MEADOW ST | ||||||||
| Address2: | |||||||||
| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148505377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073194563 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2021 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 543863 | NY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 348177 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | F348177 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.