Individual
JACQUELYN E ANDERSON
Active
Individual
JACQUELYN E ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN CHPN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
853333
TX
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
90912
OK
163WH1000X
Hospice Registered Nurse
Primary
90912
OK
Other
Enumeration date
01/17/2018
Last updated
01/17/2018
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