Provider Demographics
NPI:1861084386
Name:KENNY, JENNIFER (RN, CWON)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KENNY
Suffix:
Gender:F
Credentials:RN, CWON
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SAWGRASS DR STE 130
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4655
Mailing Address - Country:US
Mailing Address - Phone:585-262-9191
Mailing Address - Fax:585-256-2046
Practice Address - Street 1:160 SAWGRASS DR STE 130
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4655
Practice Address - Country:US
Practice Address - Phone:585-262-9191
Practice Address - Fax:585-256-2046
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY528284163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX1500XNursing Service ProvidersRegistered NurseOstomy Care