Provider Demographics
NPI:1184454225
Name:DONOHUE, JACLYN LEE MARIE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JACLYN LEE
Middle Name:MARIE
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SAVANNAH CT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2177
Mailing Address - Country:US
Mailing Address - Phone:732-773-8144
Mailing Address - Fax:
Practice Address - Street 1:202 SAVANNAH CT
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2177
Practice Address - Country:US
Practice Address - Phone:732-773-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18125000163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant