Provider Demographics
NPI:1306024575
Name:JAMES, JACQUELINE RENEA (RN)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:RENEA
Last Name:JAMES
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 1:26151 LAKE SHORE BLVD
Mailing Address - Street 2:1824
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1176
Mailing Address - Country:US
Mailing Address - Phone:216-849-5979
Mailing Address - Fax:
Practice Address - Street 1:26151 LAKE SHORE BLVD
Practice Address - Street 2:1824
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1176
Practice Address - Country:US
Practice Address - Phone:216-849-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN266320163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse