| Doctor Name: | JACQUELIN VICTORIA DEATCHER |
| NPI Number: | 1851498497 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP, CDE |
| License Number: | F303405-1 |
| Business Practice Address: | 3325 E Main Street Rd Attica, NY - 140119506 |
| Business Phone Number: | 5855473849 |
| Business Fax Number: | 5855473351 |
| Mailing Address: | 3225b Broadway Rd, ALEXANDER |
| State: | NY |
| Postal Code: | 140059760 |
| Phone Number: | 5855473849 |
| Fax Number: | 5855473351 |
| NPI Enumeration Date: | 09/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | F303405-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |