Provider Demographics
NPI:1053951707
Name:EASTMAN, JANEAN YOUNG (STUDENT NP)
Entity type:Individual
Prefix:
First Name:JANEAN
Middle Name:YOUNG
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:STUDENT NP
Other - Prefix:MISS
Other - First Name:JANEAN
Other - Middle Name:KAY
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4400 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13902-4400
Mailing Address - Country:US
Mailing Address - Phone:607-777-4954
Mailing Address - Fax:
Practice Address - Street 1:4400 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13902-4400
Practice Address - Country:US
Practice Address - Phone:607-777-4954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program