Provider Demographics
NPI:1679705529
Name:DUFFAU, JEANNETTE GRACE (RN)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:GRACE
Last Name:DUFFAU
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 1:306 KRUMVILLE RD
Mailing Address - Street 2:
Mailing Address - City:OLIVEBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12461-5527
Mailing Address - Country:US
Mailing Address - Phone:845-657-8597
Mailing Address - Fax:
Practice Address - Street 1:306 KRUMVILLE RD
Practice Address - Street 2:
Practice Address - City:OLIVEBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12461-5527
Practice Address - Country:US
Practice Address - Phone:845-657-8597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3953321163W00000X, 163WH0200X, 163WM0705X, 163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0000XNursing Service ProvidersRegistered NursePain Management