Provider Demographics
NPI:1124199559
Name:JUMP, LORENE CORNISH (NP)
Entity type:Individual
Prefix:
First Name:LORENE
Middle Name:CORNISH
Last Name:JUMP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORENE
Other - Middle Name:
Other - Last Name:CORNISH-JUMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:20 ARROWWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-266-7800
Mailing Address - Fax:607-216-0093
Practice Address - Street 1:20 ARROWWOOD DR.
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-266-7800
Practice Address - Fax:607-216-0093
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3000211363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01459874Medicaid
NY33882LMedicare UPIN
NY33882LMedicare PIN