Healthcare Provider Details

I. General information

NPI: 1326720640
Provider Name (Legal Business Name): JENEE ST JUSTE CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 BOTTLING WORKS RD
PINE BUSH NY
12566-5101
US

IV. Provider business mailing address

70 BOTTLING WORKS RD
PINE BUSH NY
12566-5101
US

V. Phone/Fax

Practice location:
  • Phone: 904-887-9924
  • Fax:
Mailing address:
  • Phone: 904-887-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25MW00004800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: