Provider Demographics
NPI:1437101532
Name:SPEIR, JEANNE FRANCES (NP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:FRANCES
Last Name:SPEIR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EASTPORT MANOR RD
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941-1410
Mailing Address - Country:US
Mailing Address - Phone:631-325-2255
Mailing Address - Fax:631-325-8562
Practice Address - Street 1:21 EASTPORT MANOR RD
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:NY
Practice Address - Zip Code:11941-1410
Practice Address - Country:US
Practice Address - Phone:631-325-2255
Practice Address - Fax:631-325-8562
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232044-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02364469Medicaid
NYG400000465Medicare PIN
NY500030261Medicare PIN
NYA400055389Medicare PIN
NY02364469Medicaid
NYA400055389Medicare PIN