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General NPI Number Information
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NPI Number | 1609202449
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Entity Type | Organization
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Legal Business Name | SMALL TOWN HEALTH CARE JENNIFER FACTEAU-RABIDEAU RN, ADULT HEALTH NP-C
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 09/25/2013
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Provider Practice Location Address
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Address Line | 345 CORNELIA ST
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City | PLATTSBURGH
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State | NY
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Zip | 12901-2377
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Country | US
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Telephone | 518-310-3090
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Fax | 518-310-3094
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Provider Business Mailing Address
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Address Line | 345 CORNELIA ST
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City | PLATTSBURGH
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State | NY
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Zip | 12901-2377
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Country | US
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Telephone | 518-310-3090
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Fax | 518-310-3094
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER AMBER FACTEAU-RABIDEAU
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Credential | ANP-C
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Telephone | 518-310-3090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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