Shattuck, Jennifer Anne

Shattuck, Jennifer Anne is an individual health care provider with primary practice located at 260 Riverside Dr , Johnson City NY 13790-2745. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Shattuck, Jennifer Anne can be contacted via phone (607) 798-7811.

Contact Information

Primary practice address
260 Riverside Dr Johnson City NY 13790-2745
Phone: (607) 798-7811
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 334772 New York

Profile Details

NPI number 1023032729
LBN Legal business name Shattuck, Jennifer Anne
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2006
Last updated Mar 19th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023032729 NPPES
New York MEDICAID 02742863

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