Provider Demographics
NPI:1356941827
Name:HOSELTON, JACQUELINE K
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:HOSELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15550 HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:DRAYTON
Mailing Address - State:ND
Mailing Address - Zip Code:58225-9606
Mailing Address - Country:US
Mailing Address - Phone:701-226-1036
Mailing Address - Fax:
Practice Address - Street 1:15550 HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:DRAYTON
Practice Address - State:ND
Practice Address - Zip Code:58225-9606
Practice Address - Country:US
Practice Address - Phone:701-226-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty