Provider Demographics
NPI:1609202449
Name:SMALL TOWN HEALTH CARE JENNIFER FACTEAU-RABIDEAU RN, ADULT HEALTH NP-C
Entity Type:Organization
Organization Name:SMALL TOWN HEALTH CARE JENNIFER FACTEAU-RABIDEAU RN, ADULT HEALTH NP-C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:AMBER
Authorized Official - Last Name:FACTEAU-RABIDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-C
Authorized Official - Phone:518-310-3090
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty