Provider Demographics
NPI:1881812022
Name:HEISER, JACQUELINE KOSAR (RN)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:KOSAR
Last Name:HEISER
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 1:2003 GOOSENECK RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-5710
Mailing Address - Country:US
Mailing Address - Phone:410-437-2814
Mailing Address - Fax:
Practice Address - Street 1:415 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2050
Practice Address - Country:US
Practice Address - Phone:410-222-6409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD157745163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool