Individual
VANESSA DEFAYETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
116 ALEXANDRIA AVE, TICONDEROGA, NY 12883-1644
(518) 834-7071
Mailing address
314 ALEXANDRIA AVE, TICONDEROGA, NY 12883-1654
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
Primary
640873
NY
Other
Enumeration date
01/03/2016
Last updated
01/03/2016
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