Provider Demographics
NPI:1780805374
Name:GIARDINO, JANICE RAE (RN)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:RAE
Last Name:GIARDINO
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 1:84 RED LION RD
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9501
Mailing Address - Country:US
Mailing Address - Phone:585-334-5015
Mailing Address - Fax:
Practice Address - Street 1:84 RED LION RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9501
Practice Address - Country:US
Practice Address - Phone:585-334-5015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263334-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02851765Medicaid