Provider Demographics
NPI:1174765382
Name:JERUM, AMY (DNP, CPNP-PC, PMHS)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:JERUM
Suffix:
Gender:F
Credentials:DNP, CPNP-PC, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7115
Mailing Address - Country:US
Mailing Address - Phone:585-276-7908
Mailing Address - Fax:585-288-1525
Practice Address - Street 1:905 CULVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7115
Practice Address - Country:US
Practice Address - Phone:585-276-7908
Practice Address - Fax:585-288-1525
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381534363LP0200X, 363LP2300X
NYF381534-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care