Individual
MATTHEW CLARK JENISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP
Contact information
Practice address
50 LEROY ST, POTSDAM, NY 13676-1786
(315) 265-3300
Mailing address
50 LEROY ST, POTSDAM, NY 13676-1786
(315) 265-3300
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
430637
NY
Other
Enumeration date
05/23/2012
Last updated
05/23/2012
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