Provider Demographics
NPI:1194154526
Name:JASON, MARYLOU E (RN)
Entity type:Individual
Prefix:MRS
First Name:MARYLOU
Middle Name:E
Last Name:JASON
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 1:4099 STATE HIGHWAY 145
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12422
Mailing Address - Country:US
Mailing Address - Phone:518-259-8412
Mailing Address - Fax:518-239-5925
Practice Address - Street 1:4099 STATE HIGHWAY 145
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NY
Practice Address - Zip Code:12422
Practice Address - Country:US
Practice Address - Phone:518-259-8412
Practice Address - Fax:518-239-5925
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401437163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics