Individual
MRS. JACQUALYN S FANELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1505 W SHERMAN AVE, VINELAND, NJ 08360-6912
(856) 641-7859
(856) 641-7671
Mailing address
PO BOX 650782, DALLAS, TX 75265-0782
(866) 709-4546
(302) 733-0854
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR07270700
NJ
367500000X
Certified Registered Nurse Anesthetist
Primary
26NJ00207600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39668
AANA
—
01
—
P00795657
RAILROAD MEDICARE
NJ
Enumeration date
05/01/2007
Last updated
09/20/2013
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