Provider Demographics
NPI:1972538635
Name:RAYNOR, JANE CRINO (RN,BSN,MSN,FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:CRINO
Last Name:RAYNOR
Suffix:
Gender:F
Credentials:RN,BSN,MSN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 WAKEMAN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-1731
Mailing Address - Country:US
Mailing Address - Phone:631-728-2071
Mailing Address - Fax:632-123-1996
Practice Address - Street 1:192 WAKEMAN RD
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-1731
Practice Address - Country:US
Practice Address - Phone:631-723-1996
Practice Address - Fax:631-723-1996
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330108-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY91N47Medicare UPIN
NYS86463Medicare UPIN