Individual
JENNIFER JOHANNESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
215 S. BROAD ST., SACKETS HARBOR, NY 13685-0290
(315) 646-3419
(315) 646-1038
Mailing address
PO BOX 290, SACKETS HARBOR, NY 13685-0290
(315) 646-3419
(315) 646-1038
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
526638-1
NY
Other
Enumeration date
09/16/2014
Last updated
09/16/2014
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