Provider Demographics
NPI:1740839299
Name:PERRY-STEWART, JACQUELINE R (RN)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:R
Last Name:PERRY-STEWART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FERRIS ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-4854
Mailing Address - Country:US
Mailing Address - Phone:315-450-1783
Mailing Address - Fax:
Practice Address - Street 1:458 BLOSSOM RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1807
Practice Address - Country:US
Practice Address - Phone:315-450-1783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334977164W00000X
NY949817163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse