Provider Demographics
NPI:1073549903
Name:OSHETSKI, JEAN W (ANP)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:W
Last Name:OSHETSKI
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 BREESPORT RD
Mailing Address - Street 2:
Mailing Address - City:ERIN
Mailing Address - State:NY
Mailing Address - Zip Code:14838-9710
Mailing Address - Country:US
Mailing Address - Phone:607-739-3309
Mailing Address - Fax:
Practice Address - Street 1:1157 BREESPORT RD
Practice Address - Street 2:
Practice Address - City:ERIN
Practice Address - State:NY
Practice Address - Zip Code:14838-9710
Practice Address - Country:US
Practice Address - Phone:607-739-3309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3021401363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02070762Medicaid
NYP05650Medicare UPIN
NYP05650Medicare UPIN