Provider Demographics
NPI:1194138156
Name:MCKINNON, JIMILAH SHEREE (RN)
Entity type:Individual
Prefix:
First Name:JIMILAH
Middle Name:SHEREE
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 GENESEE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2406
Mailing Address - Country:US
Mailing Address - Phone:585-957-0107
Mailing Address - Fax:
Practice Address - Street 1:154 GENESEE PARK BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2406
Practice Address - Country:US
Practice Address - Phone:585-957-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY673959163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse