Provider Demographics
NPI:1164644050
Name:KLEGER, JEANETTE S (CM)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:S
Last Name:KLEGER
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PLAZA DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-729-0591
Mailing Address - Fax:607-729-0967
Practice Address - Street 1:400 PLAZA DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-729-0591
Practice Address - Fax:607-729-0967
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001120176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife