Healthcare Provider Details

I. General information

NPI: 1871003541
Provider Name (Legal Business Name): JENNIFER C DION RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER DION RN

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 ROUTE 276
CHAMPLAIN NY
12919
US

IV. Provider business mailing address

103 ROUTE 276
CHAMPLAIN NY
12919
US

V. Phone/Fax

Practice location:
  • Phone: 518-298-8681
  • Fax: 518-298-2873
Mailing address:
  • Phone: 518-298-8681
  • Fax: 518-298-2873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number591248
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: