Provider Demographics
NPI:1164082111
Name:ACUAVERA, JE' SAUNDRA MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:JE' SAUNDRA
Middle Name:MICHELLE
Last Name:ACUAVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JE' SAUNDRA
Other - Middle Name:MICHELLE
Other - Last Name:BLACKBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4222 SOUTHPARK DR APT 210
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1874
Mailing Address - Country:US
Mailing Address - Phone:903-565-9069
Mailing Address - Fax:
Practice Address - Street 1:6000 KANAKANAK RD
Practice Address - Street 2:
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-842-9592
Practice Address - Fax:907-842-9303
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK145533163WC0400X
TX834314163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management