Provider Demographics
NPI:1295137263
Name:DURNELL, JACQUELINE (RN-BC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DURNELL
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 OSPREY DR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3132
Mailing Address - Country:US
Mailing Address - Phone:912-467-2983
Mailing Address - Fax:
Practice Address - Street 1:15 MOHEGAN DRIVE
Practice Address - Street 2:US COAST GUARD ACADEMY REGIONAL CLINIC
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-444-8327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT105645163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care