Provider Demographics
NPI:1831645456
Name:NEDD, JACQUELINE VALERIE
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:VALERIE
Last Name:NEDD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 SUMNEYTOWN PIKE
Mailing Address - Street 2:P.O. BOX 902
Mailing Address - City:GWYNEDD VALEY
Mailing Address - State:PA
Mailing Address - Zip Code:19437
Mailing Address - Country:US
Mailing Address - Phone:347-401-4665
Mailing Address - Fax:
Practice Address - Street 1:1349 SUMNEYTOWN PIKE, LOWER GYNEDD TOWNSHIP
Practice Address - Street 2:
Practice Address - City:GWYNEDD VALEY
Practice Address - State:PA
Practice Address - Zip Code:19437
Practice Address - Country:US
Practice Address - Phone:347-401-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY555093-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse