Provider Demographics
NPI:1568684033
Name:JAUK, MAE ANNE ALBERTO (MA, APRN-BC)
Entity Type:Individual
Prefix:
First Name:MAE ANNE
Middle Name:ALBERTO
Last Name:JAUK
Suffix:
Gender:F
Credentials:MA, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 9317
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06904
Mailing Address - Country:US
Mailing Address - Phone:203-276-2695
Mailing Address - Fax:
Practice Address - Street 1:HEMATOLOGY ONCOLOGY PC
Practice Address - Street 2:1 HOSPITAL PLAZA
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06904
Practice Address - Country:US
Practice Address - Phone:203-276-2695
Practice Address - Fax:203-975-7842
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003113363LA2200X
NY303782363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02975524Medicaid
NY02975524Medicaid