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General NPI Number Information
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NPI Number | 1225359896
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Entity Type | Individual
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Provider Name | JACQUELINE ANN LANDOLF R.N.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 555 WARREN RD
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City | ITHACA
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State | NY
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Zip | 14850-1862
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Country | US
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Telephone | 607-257-1555
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Fax | 607-697-8220
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Provider Business Mailing Address
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Address Line | 555 WARREN RD
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City | ITHACA
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State | NY
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Zip | 14850-1862
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Country | US
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Telephone | 607-257-1555
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Fax | 607-697-8220
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 253851-1
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License Number State | NY
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