Healthcare Provider Details

I. General information

NPI: 1437101532
Provider Name (Legal Business Name): JEANNE FRANCES SPEIR N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 EASTPORT MANOR RD
EASTPORT NY
11941-1410
US

IV. Provider business mailing address

21 EASTPORT MANOR RD
EASTPORT NY
11941-1410
US

V. Phone/Fax

Practice location:
  • Phone: 631-325-2255
  • Fax: 631-325-8562
Mailing address:
  • Phone: 631-325-2255
  • Fax: 631-325-8562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number232044-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: