Individual
AMANDA JAQUAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
111 FREDERICK ST, ILION, NY 13357-2541
(315) 895-7471
Mailing address
20 E SPOFFORD AVE, DOLGEVILLE, NY 13329-1478
(315) 717-1875
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
716108
NY
Other
Enumeration date
09/28/2021
Last updated
10/26/2021
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