Provider Demographics
NPI:1891853198
Name:JACQUES, VALERIE A (RN, CPM, NHCM)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:JACQUES
Suffix:
Gender:F
Credentials:RN, CPM, NHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FRYING PAN LN
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2506
Mailing Address - Country:US
Mailing Address - Phone:603-580-2327
Mailing Address - Fax:603-580-2326
Practice Address - Street 1:13 FRYING PAN LN
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2506
Practice Address - Country:US
Practice Address - Phone:603-580-2327
Practice Address - Fax:603-580-2326
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1009175M00000X
NH015158-21367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered175M00000XOther Service ProvidersMidwife, Lay
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30462658Medicaid