Provider Demographics
NPI:1477319721
Name:DRUSCH, JACLYN (RN IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:
Last Name:DRUSCH
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 GOODNIGHT TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8404
Mailing Address - Country:US
Mailing Address - Phone:262-309-2577
Mailing Address - Fax:
Practice Address - Street 1:2622 GOODNIGHT TRL
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8404
Practice Address - Country:US
Practice Address - Phone:262-309-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151243163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant