Healthcare Provider Details

I. General information

NPI: 1962642397
Provider Name (Legal Business Name): TINA FACTEAU BSN,RN,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK ST 3RD FLOOR PRUYN PAVILION
GLENS FALLS NY
12801-4449
US

IV. Provider business mailing address

102 PARK ST 3RD FLOOR PRUYN PAVILION
GLENS FALLS NY
12801
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-2610
  • Fax: 518-926-2091
Mailing address:
  • Phone: 518-926-2610
  • Fax: 518-926-2091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number442838
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: