Provider Demographics
NPI:1942475306
Name:HEARN, JACQUELINE (CRNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HEARN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 HALTER RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-1901
Mailing Address - Country:US
Mailing Address - Phone:410-857-8202
Mailing Address - Fax:410-857-8205
Practice Address - Street 1:688C POOLE RD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6003
Practice Address - Country:US
Practice Address - Phone:410-857-8202
Practice Address - Fax:410-857-8205
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR069707363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P84773Medicare UPIN