Provider Demographics
NPI:1174975858
Name:HONER, JENNIFER M (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:HONER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:GICZKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9443 E HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14080-9797
Mailing Address - Country:US
Mailing Address - Phone:716-864-4418
Mailing Address - Fax:
Practice Address - Street 1:3218 WALDEN AVE
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-2878
Practice Address - Country:US
Practice Address - Phone:716-923-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04548129Medicaid