Provider Demographics
NPI:1083316442
Name:SPEARS, JACQUELINE LYNN (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:LYNN
Last Name:SPEARS
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 1:2411 BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8602
Mailing Address - Country:US
Mailing Address - Phone:812-455-3462
Mailing Address - Fax:812-474-3697
Practice Address - Street 1:6211 WATERFORD BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2869
Practice Address - Country:US
Practice Address - Phone:812-465-6202
Practice Address - Fax:812-474-3697
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28133151A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse