Provider Demographics
NPI:1952953838
Name:WETHERBEE, JACQUELINE (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:WETHERBEE
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23030-2847
Mailing Address - Country:US
Mailing Address - Phone:678-333-8061
Mailing Address - Fax:
Practice Address - Street 1:10521 SHADY LN
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:VA
Practice Address - Zip Code:23030-2847
Practice Address - Country:US
Practice Address - Phone:678-333-8061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540911387OtherTIN