Provider Demographics
NPI:1962642397
Name:FACTEAU, TINA (BSN,RN,CDE)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:FACTEAU
Suffix:
Gender:F
Credentials:BSN,RN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PARK ST
Mailing Address - Street 2:3RD FLOOR PRUYN PAVILION
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-926-2610
Mailing Address - Fax:518-926-2091
Practice Address - Street 1:102 PARK ST
Practice Address - Street 2:3RD FLOOR PRUYN PAVILION
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4449
Practice Address - Country:US
Practice Address - Phone:518-926-2610
Practice Address - Fax:518-926-2091
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY442838163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator