Provider Demographics
NPI:1871800821
Name:WELBECK, JACQUELINE P (RN)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:P
Last Name:WELBECK
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 1:5 JEROME DR
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-2603
Mailing Address - Country:US
Mailing Address - Phone:914-737-2286
Mailing Address - Fax:914-737-2286
Practice Address - Street 1:5 JEROME DR
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-2603
Practice Address - Country:US
Practice Address - Phone:914-737-2286
Practice Address - Fax:914-737-2286
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451669163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse