Provider Demographics
NPI:1114501061
Name:TAFT, JANNIE L
Entity Type:Individual
Prefix:
First Name:JANNIE
Middle Name:L
Last Name:TAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 DEE RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:NY
Mailing Address - Zip Code:14821-9780
Mailing Address - Country:US
Mailing Address - Phone:607-794-4113
Mailing Address - Fax:
Practice Address - Street 1:7509 DEE RD
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:NY
Practice Address - Zip Code:14821-9780
Practice Address - Country:US
Practice Address - Phone:607-794-4113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider