Basic Information
| Provider Information | |||||||||
| NPI: | 1790818458 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BATTLE | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 READE PL | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126013947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454836559 | ||||||||
| FaxNumber: | 8454836108 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 READE PL | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126013947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454836559 | ||||||||
| FaxNumber: | 8454836108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 01/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F335095 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LN0000X | F335095 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
ID Information
| ID | Type | State | Issuer | Description | 02873027 | 05 | NY | MEDICAID |