Provider Demographics
NPI:1164481396
Name:MEADOWS, JACQUELINE L (NP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 NORMA DR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1348
Mailing Address - Country:US
Mailing Address - Phone:603-718-8728
Mailing Address - Fax:
Practice Address - Street 1:21 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6744
Practice Address - Country:US
Practice Address - Phone:603-577-3003
Practice Address - Fax:603-577-3331
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177806363LF0000X
NH0312952303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily