Individual
MRS. JESSICA MARIE MENNELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-C
Contact information
Practice address
1991 MARCUS AVE, NEW HYDE PARK, NY 11042-2057
(516) 354-1600
(516) 941-4677
Mailing address
55 WATER ST FL 12, NEW YORK, NY 10041-0004
(646) 680-2888
(516) 542-5556
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
307519
NY
363LG0600X
Gerontology Nurse Practitioner
307519
NY
Other
Enumeration date
01/14/2016
Last updated
11/10/2017
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