Provider Demographics
NPI:1700266467
Name:LAGUNDA, JACQUELINE KAGUYUTAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:KAGUYUTAN
Last Name:LAGUNDA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:SANTOS
Other - Last Name:KAGUYUTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:770 WOODLANE RD
Mailing Address - Street 2:N/A
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-3804
Mailing Address - Country:US
Mailing Address - Phone:609-267-5928
Mailing Address - Fax:609-267-2318
Practice Address - Street 1:770 WOODLANE RD
Practice Address - Street 2:N/A
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-3804
Practice Address - Country:US
Practice Address - Phone:609-267-5928
Practice Address - Fax:609-267-2318
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12367500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse