Provider Demographics
NPI:1154817633
Name:BROE, JENAYE KARIN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JENAYE
Middle Name:KARIN
Last Name:BROE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 RED BARN CIR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4988
Mailing Address - Country:US
Mailing Address - Phone:607-287-2461
Mailing Address - Fax:
Practice Address - Street 1:4000 MEDICAL CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6631
Practice Address - Country:US
Practice Address - Phone:315-663-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-08
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343229-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily