Basic Information
| Provider Information | |||||||||
| NPI: | 1477746865 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAVELING | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY MEDICAL CENTER STONY BRK | ||||||||
| Address2: | STONY BROOK HOSPITAL, DEPT MEDICINE, HOSPITAL 15N-082 | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314443318 | ||||||||
| FaxNumber: | 6314441235 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY MEDICAL CENTER STONY BRK | ||||||||
| Address2: | STONY BROOK HOSPITAL, DEPT MEDICINE, HOSPITAL 15N-082 | ||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117948160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314443318 | ||||||||
| FaxNumber: | 6314441235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 03/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F300620 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.