Healthcare Provider Details

I. General information

NPI: 1033450143
Provider Name (Legal Business Name): JACQUELINE RENEE LABELLE R-PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 LIMESTONE DR
WILLIAMSVILLE NY
14221-8602
US

IV. Provider business mailing address

18 LIMESTONE DR
WILLIAMSVILLE NY
14221-8602
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1400
  • Fax: 716-632-5316
Mailing address:
  • Phone: 716-632-1400
  • Fax: 716-632-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016455-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: