Provider Demographics
NPI:1194791475
Name:ROUNDS, JANE M (FNP-BC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:ROUNDS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:M
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:3 BRIDGE STREET
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1323
Mailing Address - Country:US
Mailing Address - Phone:315-493-7334
Mailing Address - Fax:315-493-1811
Practice Address - Street 1:3 BRIDGE STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1323
Practice Address - Country:US
Practice Address - Phone:315-493-7334
Practice Address - Fax:315-493-1811
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332611363L00000X
NYF332611-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02099021Medicaid
DD6447Medicare ID - Type Unspecified
NY02099021Medicaid