Provider Demographics
NPI:1316414170
Name:MANJARREZ DELGADO, JAQUELINE (RN, RNFA)
Entity Type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:
Last Name:MANJARREZ DELGADO
Suffix:
Gender:F
Credentials:RN, RNFA
Other - Prefix:
Other - First Name:JAQUELINE
Other - Middle Name:
Other - Last Name:MANJARREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:32223 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-5603
Mailing Address - Country:US
Mailing Address - Phone:509-759-3691
Mailing Address - Fax:
Practice Address - Street 1:34515 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6761
Practice Address - Country:US
Practice Address - Phone:253-835-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60431291163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant