Individual
JACKALYN DESPAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
56 MARKET ST, POTSDAM, NY 13676-1747
(315) 265-4065
Mailing address
56 MARKET ST, POTSDAM, NY 13676-1747
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
616272
NY
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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