| NPI | 1932625258 |
|---|---|
| Former Name | JENNA MARIE MACONE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 026742) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 26742) |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2023-07-22 |