Provider Demographics
NPI:1033450143
Name:LABELLE, JACQUELINE RENEE (R-PAC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RENEE
Last Name:LABELLE
Suffix:
Gender:F
Credentials:R-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LIMESTONE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8602
Mailing Address - Country:US
Mailing Address - Phone:716-632-1400
Mailing Address - Fax:716-632-5316
Practice Address - Street 1:18 LIMESTONE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8602
Practice Address - Country:US
Practice Address - Phone:716-632-1400
Practice Address - Fax:716-632-5316
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016455-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant