Provider Demographics
NPI:1174131239
Name:DON, JACQUELYNE NICOLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYNE
Middle Name:NICOLE
Last Name:DON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-1604
Mailing Address - Country:US
Mailing Address - Phone:631-229-6653
Mailing Address - Fax:
Practice Address - Street 1:28 GROVE DR
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-1604
Practice Address - Country:US
Practice Address - Phone:631-229-6653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229921164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse