Provider Demographics
NPI:1891389581
Name:WARREN, JACQUELINE PARKS (RN, MSN, CMSRN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:PARKS
Last Name:WARREN
Suffix:
Gender:F
Credentials:RN, MSN, CMSRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-4037
Mailing Address - Country:US
Mailing Address - Phone:504-812-1344
Mailing Address - Fax:
Practice Address - Street 1:657 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-4037
Practice Address - Country:US
Practice Address - Phone:504-812-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN094472163WC1500X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health