Provider Demographics
NPI:1043797665
Name:STEIN, JACQUELYN GRACE (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:GRACE
Last Name:STEIN
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 1:3508 FAR WEST BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3081
Mailing Address - Country:US
Mailing Address - Phone:512-828-3990
Mailing Address - Fax:
Practice Address - Street 1:2801 S LAKELINE BLVD APT 11102
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1785
Practice Address - Country:US
Practice Address - Phone:512-680-9224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX881288163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse