Provider Demographics
NPI:1447528336
Name:LAPE, JACQUELINE ANN (RN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:LAPE
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 1:61 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13452-1125
Mailing Address - Country:US
Mailing Address - Phone:518-568-2013
Mailing Address - Fax:518-568-3016
Practice Address - Street 1:61 MONROE ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13452-1125
Practice Address - Country:US
Practice Address - Phone:518-568-2013
Practice Address - Fax:518-568-3016
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292962-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01383595Medicaid