Provider Demographics
NPI:1518143197
Name:NEAL, JACQULINE DELORISE (RN-ADN)
Entity Type:Individual
Prefix:
First Name:JACQULINE
Middle Name:DELORISE
Last Name:NEAL
Suffix:
Gender:F
Credentials:RN-ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S HIGHWAY 1417 APT 1407
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-4889
Mailing Address - Country:US
Mailing Address - Phone:903-815-6249
Mailing Address - Fax:
Practice Address - Street 1:900 S HIGHWAY 1417 APT 1407
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-4889
Practice Address - Country:US
Practice Address - Phone:903-815-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX635291163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse