Provider Demographics
NPI:1164932315
Name:FALTER-SOUTO, JENNY (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:FALTER-SOUTO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3003
Mailing Address - Country:US
Mailing Address - Phone:631-687-4188
Mailing Address - Fax:631-687-2879
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3003
Practice Address - Country:US
Practice Address - Phone:631-687-4188
Practice Address - Fax:631-687-2879
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY573388-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse