Individual
JENNIFER THAKUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
4870 BROAD RD, POB NORTH SUITE 3Q, SYRACUSE, NY 13215-2206
(315) 492-5292
(315) 701-0544
Mailing address
4870 BROAD RD, POB NORTH SUITE 3Q, SYRACUSE, NY 13215-2206
(315) 492-5292
(315) 701-0544
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
306245
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
NYS LICENSE
NY
Enumeration date
09/25/2008
Last updated
10/19/2012
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