Provider Demographics
NPI:1154554632
Name:FENNESSEY, JEANNE SANDRA (LPN)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:SANDRA
Last Name:FENNESSEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JEANNE
Other - Middle Name:SANDRA
Other - Last Name:LAMANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:450 HAZELHURST AVE
Mailing Address - Street 2:APT.#9
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2145
Mailing Address - Country:US
Mailing Address - Phone:315-863-4917
Mailing Address - Fax:
Practice Address - Street 1:450 HAZELHURST AVE
Practice Address - Street 2:APT.#9
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2145
Practice Address - Country:US
Practice Address - Phone:315-863-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229263-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse