Provider Demographics
NPI:1962101717
Name:DRAKE, JANE MARJORIE (RN)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:MARJORIE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:MARJORIE
Other - Last Name:VANDENBRUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:70 VAN WYCK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2954
Mailing Address - Country:US
Mailing Address - Phone:845-309-6222
Mailing Address - Fax:
Practice Address - Street 1:41 PAGE PARK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:NY
Practice Address - Zip Code:12603-7500
Practice Address - Country:US
Practice Address - Phone:845-486-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320457163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse