Provider Demographics
NPI:1124660170
Name:ABBENSETTS, JENNY HAZEL
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:HAZEL
Last Name:ABBENSETTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 GARIBALDI AVE APT 26
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2538
Mailing Address - Country:US
Mailing Address - Phone:646-236-9452
Mailing Address - Fax:
Practice Address - Street 1:222 GARIBALDI AVE APT 26
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2538
Practice Address - Country:US
Practice Address - Phone:646-236-9452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY585143-1163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management