Provider Demographics
NPI:1124247713
Name:MONNELL, JANE RUTH (APRN BC FNP)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:RUTH
Last Name:MONNELL
Suffix:
Gender:F
Credentials:APRN BC FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1116
Mailing Address - Country:US
Mailing Address - Phone:315-672-9641
Mailing Address - Fax:
Practice Address - Street 1:421 MONTGOMERY ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-435-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331899-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMM0776976OtherDEA NUMBER EXPIRED
NYB B3174Medicare ID - Type Unspecified
NYS72667Medicare UPIN