Provider Demographics
NPI:1598013989
Name:TEAGUE, JANE M (RN)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:M
Last Name:TEAGUE
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 1:6 LEGEND ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3061
Mailing Address - Country:US
Mailing Address - Phone:631-928-9095
Mailing Address - Fax:
Practice Address - Street 1:6 LEGEND ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3061
Practice Address - Country:US
Practice Address - Phone:631-928-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2812761163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse