Provider Demographics
NPI:1962855262
Name:KRAAI, JACKIE (RN00120978)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:KRAAI
Suffix:
Gender:F
Credentials:RN00120978
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:KRAAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:8003 ZAYAS DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-7944
Mailing Address - Country:US
Mailing Address - Phone:509-380-6621
Mailing Address - Fax:
Practice Address - Street 1:8003 ZAYAS DR
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-7944
Practice Address - Country:US
Practice Address - Phone:509-380-6621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00120978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse