Provider Demographics
NPI:1801130729
Name:BANIQUED, JADELYN T (FNP)
Entity type:Individual
Prefix:MS
First Name:JADELYN
Middle Name:T
Last Name:BANIQUED
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BG CRAWFORD F. SAMS US ARMY HEALTH CLINIC
Mailing Address - Street 2:SHINDO, MINAMI WARD, SAGAMIHARA
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:25203-2600
Mailing Address - Country:US
Mailing Address - Phone:315-263-3537
Mailing Address - Fax:
Practice Address - Street 1:BG CRAWFORD SAMS US ARMY HEALTH CLINIC
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96338
Practice Address - Country:US
Practice Address - Phone:315-263-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI57318390200000X
HIAPRN-1987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program