Provider Demographics
NPI:1164642427
Name:JERABECK, JANICE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:JERABECK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:MARIE
Other - Last Name:GOOGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1639 DELPHI RD
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035
Mailing Address - Country:US
Mailing Address - Phone:315-662-7725
Mailing Address - Fax:
Practice Address - Street 1:766 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:SHERBURNE
Practice Address - State:NY
Practice Address - Zip Code:13460
Practice Address - Country:US
Practice Address - Phone:607-674-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4853361163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01697483Medicaid