Provider Demographics
NPI:1356320600
Name:LAFRANCE, JOLENE B (NP)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:B
Last Name:LAFRANCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1571 WASHINGTON ST STE 104
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9304
Mailing Address - Country:US
Mailing Address - Phone:315-786-0224
Mailing Address - Fax:315-836-2210
Practice Address - Street 1:1571 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9346
Practice Address - Country:US
Practice Address - Phone:315-786-0224
Practice Address - Fax:315-469-8506
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-14
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD1947Medicare PIN
NYP21899Medicare UPIN
NYP00106027Medicare PIN