Individual
JACQUELIN VICTORIA DEATCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP, CDE
Contact information
Practice address
3325 E MAIN STREET RD, ATTICA, NY 14011-9506
(585) 547-3849
(585) 547-3351
Mailing address
3225B BROADWAY RD, ALEXANDER, NY 14005-9760
(585) 547-3849
(585) 547-3351
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F303405-1
NY
Other
Enumeration date
09/17/2006
Last updated
07/08/2007
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