Provider Demographics
NPI:1942290259
Name:FIELDS, JANE (CNM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 N MAIN ST
Mailing Address - Street 2:STE 100A
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1644
Mailing Address - Country:US
Mailing Address - Phone:315-423-9722
Mailing Address - Fax:315-423-9687
Practice Address - Street 1:770 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2117
Practice Address - Country:US
Practice Address - Phone:315-422-2222
Practice Address - Fax:315-472-8497
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF000122-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02385106Medicaid
NYP01831Medicare UPIN
NY02385106Medicaid