Provider Demographics
NPI:1861851842
Name:FACTEAU, LINDA SUE (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:FACTEAU
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:P.O. BOX 455
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-561-0100
Mailing Address - Fax:518-561-2390
Practice Address - Street 1:1585 MILITARY TURNPIKE
Practice Address - Street 2:
Practice Address - City:PLATTSBRUGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-561-0100
Practice Address - Fax:518-561-2390
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22482918163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool