Organization Name: | JACQUELINE G. HANCOCK, CRNA, PA |
NPI Number: | 1013194695 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACQUELINE GWEN HANCOCK (NURSE ANESTHETIST) |
Mailing Address: | 686 B Poole Road Westminster |
State: | MARYLAND AF |
Postal Code: | 21157 |
Phone Number: | 4108482203 |
Fax Number: | |
NPI Enumeration Date: | 01/26/2008 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | R036423 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |