Provider Demographics
NPI:1871033738
Name:CLAUDE, JACQUELYN DAWN (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:DAWN
Last Name:CLAUDE
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 1:12841 DAYBREAK CIR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-9511
Mailing Address - Country:US
Mailing Address - Phone:757-401-2250
Mailing Address - Fax:
Practice Address - Street 1:12841 DAYBREAK CIR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-9511
Practice Address - Country:US
Practice Address - Phone:757-401-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001179754163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse