Provider Demographics
NPI:1265318737
Name:MAEWEATHER, JAQUELLIN JANEVA (RN)
Entity type:Individual
Prefix:PROF
First Name:JAQUELLIN
Middle Name:JANEVA
Last Name:MAEWEATHER
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 1:2029 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-7309
Mailing Address - Country:US
Mailing Address - Phone:918-582-7228
Mailing Address - Fax:918-560-1399
Practice Address - Street 1:2029 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-7309
Practice Address - Country:US
Practice Address - Phone:918-582-7228
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK217396163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse