Provider Demographics
NPI:1437706892
Name:AYUSO, JACQUELINE (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:AYUSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:ANTOINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 NORTH MAIN STREET
Mailing Address - Street 2:E & D
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904
Mailing Address - Country:US
Mailing Address - Phone:401-228-6579
Mailing Address - Fax:
Practice Address - Street 1:530 NORTH MAIN STREET
Practice Address - Street 2:E & D
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-228-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN57101163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse