Provider Demographics
NPI:1437406477
Name:FACTEAU-RABIDEAU, JENNIFER AMBER (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AMBER
Last Name:FACTEAU-RABIDEAU
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 1:345 CORNELIA ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2377
Mailing Address - Country:US
Mailing Address - Phone:518-310-3090
Mailing Address - Fax:518-310-3094
Practice Address - Street 1:345 CORNELIA ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2377
Practice Address - Country:US
Practice Address - Phone:518-310-3090
Practice Address - Fax:518-310-3094
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30 306177363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health