Provider Demographics
NPI:1306229786
Name:CAVALLERO, JACQUELINE LEE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LEE
Last Name:CAVALLERO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BIRKDALE CIR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-1449
Mailing Address - Country:US
Mailing Address - Phone:610-462-8735
Mailing Address - Fax:
Practice Address - Street 1:3015 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1114
Practice Address - Country:US
Practice Address - Phone:610-462-8735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily