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Individual

JANE M PRENDERGAST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
218 STONE ST FL 2, COMMUNITY CLINIC OF JEFFERSON COUNTY, WATERTOWN, NY 13601-3211
(315) 782-7445
(315) 779-1184
Mailing address
338 FRENCHS BAY RD, TULLY, NY 13159-9440
(315) 317-6940

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
303635
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F400868
NY

Other

Enumeration date
10/19/2006
Last updated
07/29/2011
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