Provider Demographics
NPI:1194739896
Name:WHITE, JACQUELYNN A (RN, MSN, NP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYNN
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN, MSN, NP
Other - Prefix:
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Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 215
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-963-2439
Practice Address - Fax:856-338-9211
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN10079400163WX0200X, 364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ023483Medicare PIN