Provider Demographics
NPI:1346522125
Name:DEYAEGER, CAROL (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:DEYAEGER
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 1:800 TAIT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-2309
Mailing Address - Country:US
Mailing Address - Phone:585-966-3800
Mailing Address - Fax:585-581-8370
Practice Address - Street 1:800 TAIT AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-2309
Practice Address - Country:US
Practice Address - Phone:585-966-3800
Practice Address - Fax:585-581-8370
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY532049695163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY163WS0200XMedicaid