Provider Demographics
NPI:1265799241
Name:JOSEPH, JACQUELINE (RN)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 129TH
Mailing Address - Street 2:HCZ PROMISE ACADEMY I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027
Mailing Address - Country:US
Mailing Address - Phone:646-480-3855
Mailing Address - Fax:
Practice Address - Street 1:330 LIVINGSTON PLACE 2ND FLOOR
Practice Address - Street 2:PENDA AIKEN INC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217
Practice Address - Country:US
Practice Address - Phone:718-643-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY555089163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse