Provider Demographics
NPI:1104195189
Name:ESTABROOK-POLLACK, JO-ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:JO-ELLEN
Middle Name:
Last Name:ESTABROOK-POLLACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ROUTE 9 2910
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184
Mailing Address - Country:US
Mailing Address - Phone:518-758-7676
Mailing Address - Fax:518-758-1405
Practice Address - Street 1:2910 ROUTE 9
Practice Address - Street 2:PO 820
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184
Practice Address - Country:US
Practice Address - Phone:518-758-7676
Practice Address - Fax:518-758-1405
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2871441163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool