Provider Demographics
NPI:1255326781
Name:CONROE, JACQUELYN M (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:M
Last Name:CONROE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:M
Other - Last Name:NALBONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:17 SHERMAN ST
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-7080
Mailing Address - Country:US
Mailing Address - Phone:716-661-9730
Mailing Address - Fax:716-661-9732
Practice Address - Street 1:17 SHERMAN ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-7080
Practice Address - Country:US
Practice Address - Phone:716-661-9730
Practice Address - Fax:716-661-9732
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY522434-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse