Jacqueline Lee Capone
Individual provider Active NPI Specialist · Watertown, NY
NPI 1215523121 · NPPES record last updated Dec 15, 2020
Key facts
- NPI
- 1215523121
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 16783 Ives Street Ext
Watertown, NY 13601-5312 - Phone
- (315) 788-5377
- NPI assigned
- Dec 15, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | NY | Yes |
Addresses
Primary practice location
16783 Ives Street Ext
Watertown, NY 13601-5312
Mailing address
377 Broadway Ave W
Watertown, NY 13601-4103
Phone (720) 369-3121
Other providers in Watertown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.