Provider Demographics
NPI:1326054438
Name:HORNER, JACQUELINE LEE
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LEE
Last Name:HORNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 CHALKSTONE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4799
Mailing Address - Country:US
Mailing Address - Phone:401-273-7100
Mailing Address - Fax:401-457-3345
Practice Address - Street 1:830 CHALKSTONE AVENUE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4799
Practice Address - Country:US
Practice Address - Phone:401-273-7100
Practice Address - Fax:401-457-3345
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI21310163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care