Provider Demographics
NPI:1780929349
Name:JAUREQUE, MICHAEL DALEN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DALEN
Last Name:JAUREQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 HILLTOP CIR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:TN
Mailing Address - Zip Code:38011-6628
Mailing Address - Country:US
Mailing Address - Phone:901-569-8012
Mailing Address - Fax:
Practice Address - Street 1:159 HILLTOP CIR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:TN
Practice Address - Zip Code:38011-6628
Practice Address - Country:US
Practice Address - Phone:901-569-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker