Provider Demographics
NPI:1538478409
Name:BAIN, JANE THERESE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:THERESE
Last Name:BAIN
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 1:84 NIGHTENGALE AVE
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-2538
Mailing Address - Country:US
Mailing Address - Phone:315-764-3730
Mailing Address - Fax:315-764-3739
Practice Address - Street 1:84 NIGHTENGALE AVE
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-2538
Practice Address - Country:US
Practice Address - Phone:315-764-3730
Practice Address - Fax:315-764-3739
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY416018163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool