Provider Demographics
NPI:1043367949
Name:CABANA, JACQUELINE MALIA (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MALIA
Last Name:CABANA
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:CMR 422 BOX 837
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09067
Mailing Address - Country:DE
Mailing Address - Phone:490631-354-9872
Mailing Address - Fax:
Practice Address - Street 1:HEIDELBERG MEDDAC-DARMSTADT
Practice Address - Street 2:UNIT 29500 BOX 0015
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09175
Practice Address - Country:DE
Practice Address - Phone:490615-169-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-91616-062163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse