Provider Demographics
NPI:1104190446
Name:GILLETTE, JANE M (RN)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:M
Last Name:GILLETTE
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 1:4791 EAST RD
Mailing Address - Street 2:
Mailing Address - City:TURIN
Mailing Address - State:NY
Mailing Address - Zip Code:13473-1713
Mailing Address - Country:US
Mailing Address - Phone:315-348-8681
Mailing Address - Fax:315-348-2510
Practice Address - Street 1:4791 EAST RD
Practice Address - Street 2:
Practice Address - City:TURIN
Practice Address - State:NY
Practice Address - Zip Code:13473-1713
Practice Address - Country:US
Practice Address - Phone:315-348-8681
Practice Address - Fax:315-348-2510
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214736-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool