Provider Demographics
NPI:1235564287
Name:MACDONALD, JACLYN OLIVIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:OLIVIA
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CAMPMEETING ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1337
Mailing Address - Country:US
Mailing Address - Phone:607-621-2537
Mailing Address - Fax:
Practice Address - Street 1:66 CAMPMEETING ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1337
Practice Address - Country:US
Practice Address - Phone:607-621-2537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310566-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse