Individual provider · Type 1 NPI
Jean Elizabeth Mack-Fogg
Pediatric Nurse Practitioner · Rochester, NY
NPI number
1023048600
Active
Practice location
601 Elmwood Ave
Rochester, NY 14642
Other practice locations
- 800 Howard Ave, New Haven, CT 06519-1369 · (203) 785-4216
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | F380190 (NY) |
| Pediatric Nurse Practitioner Primary | 363LP0200X | 7475 (CT) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1023048600
Jean Elizabeth Mack-Fogg's National Provider Identifier is 1023048600, issued on Jul 3, 2006. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Rochester, NY. The record was last updated on Jul 24, 2018.