Provider Demographics
NPI:1962775536
Name:SALVATORE, JENNIFER M (LPN)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:M
Last Name:SALVATORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7529 GLENCREST AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4149
Mailing Address - Country:US
Mailing Address - Phone:315-451-2385
Mailing Address - Fax:
Practice Address - Street 1:7529 GLENCREST AVE
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4149
Practice Address - Country:US
Practice Address - Phone:315-451-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294249164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse