Provider Demographics
NPI:1801510359
Name:VENABLE, JACQUELIN
Entity type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:
Last Name:VENABLE
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 1:2228 MARTIN LUTHER KING JR AVE SE APT 224
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5759
Mailing Address - Country:US
Mailing Address - Phone:202-710-1725
Mailing Address - Fax:
Practice Address - Street 1:1200 N CAPITOL ST NW APT B208
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7517
Practice Address - Country:US
Practice Address - Phone:202-855-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant