Provider Demographics
NPI:1558993808
Name:DONNELLY, JACQUELINE KARUNGI (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:KARUNGI
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 CALIFORNIA TRL
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-4914
Mailing Address - Country:US
Mailing Address - Phone:845-667-0252
Mailing Address - Fax:
Practice Address - Street 1:712 CALIFORNIA TRL
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4914
Practice Address - Country:US
Practice Address - Phone:845-667-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX984605163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse