Healthcare Provider Details

I. General information

NPI: 1972538635
Provider Name (Legal Business Name): JANE CRINO RAYNOR RN,BSN,MSN,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 WAKEMAN RD
HAMPTON BAYS NY
11946-1731
US

IV. Provider business mailing address

192 WAKEMAN RD
HAMPTON BAYS NY
11946-1731
US

V. Phone/Fax

Practice location:
  • Phone: 631-723-1996
  • Fax: 631-723-1996
Mailing address:
  • Phone: 631-728-2071
  • Fax: 632-123-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number330108-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: