Provider Demographics
NPI:1184006215
Name:JAKUBEK, MARY S (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:S
Last Name:JAKUBEK
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 1:1157 ROUTE 55
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5021
Mailing Address - Country:US
Mailing Address - Phone:845-486-4860
Mailing Address - Fax:845-483-3610
Practice Address - Street 1:1157 ROUTE 55
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5021
Practice Address - Country:US
Practice Address - Phone:845-486-4860
Practice Address - Fax:845-483-3610
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY473884-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool