Provider Demographics
NPI:1043603970
Name:HOWARD, JACQUELINE (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HOWARD
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:PO BOX 186
Mailing Address - Street 2:MILE POST 1314 ALASKA HWY
Mailing Address - City:TOK
Mailing Address - State:AK
Mailing Address - Zip Code:99780-0186
Mailing Address - Country:US
Mailing Address - Phone:907-883-4101
Mailing Address - Fax:907-883-4102
Practice Address - Street 1:MILE POST 1314 ALASKA HWY
Practice Address - Street 2:
Practice Address - City:TOK
Practice Address - State:AK
Practice Address - Zip Code:99780-0186
Practice Address - Country:US
Practice Address - Phone:907-883-4101
Practice Address - Fax:907-883-4102
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK38009163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health