Provider Demographics
NPI:1639534373
Name:MELDRUM, JACQUELYN ELLEN (RN, MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ELLEN
Last Name:MELDRUM
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26655 ROCK LAKE CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134-8313
Mailing Address - Country:US
Mailing Address - Phone:520-404-6696
Mailing Address - Fax:
Practice Address - Street 1:26655 ROCK LAKE CT
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134-8313
Practice Address - Country:US
Practice Address - Phone:520-404-6696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3948816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse