Provider Demographics
NPI:1942496682
Name:TUOHEY, JACQUELINE C (LPN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:C
Last Name:TUOHEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:C
Other - Last Name:TUOHEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:5440 BORGASE LN
Mailing Address - Street 2:P.O. BOX 102
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-8906
Mailing Address - Country:US
Mailing Address - Phone:315-668-7967
Mailing Address - Fax:
Practice Address - Street 1:5440 BORGASE LN
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-8906
Practice Address - Country:US
Practice Address - Phone:315-668-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264348-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02330683Medicaid