Provider Demographics
NPI:1902181043
Name:EDENS, JACQUELYN CURRERI (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:CURRERI
Last Name:EDENS
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 1:3 E LEE ST
Mailing Address - Street 2:PEDIATRICS AT THE HARBOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-6000
Mailing Address - Country:US
Mailing Address - Phone:443-682-6610
Mailing Address - Fax:
Practice Address - Street 1:3 E LEE ST
Practice Address - Street 2:PEDIATRICS AT THE HARBOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-6000
Practice Address - Country:US
Practice Address - Phone:443-682-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR069315163WC0400X, 163WP0200X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care