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Individual

MRS. JENNIFER L FORTUNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
REGISTERED NURSE

Contact information

Practice address
221 HAMILTON ST, OGDENSBURG, NY 13669-1707
(315) 541-3042
Mailing address
221 HAMILTON ST, OGDENSBURG, NY 13669-1707
(315) 748-3924

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
565897
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1578559159
THIRD PARTY
NY
05
1578559159
NY
Enumeration date
05/18/2021
Last updated
05/18/2021
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