Provider Demographics
NPI:1285405670
Name:EDWERS, JACLYN N (RN)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:N
Last Name:EDWERS
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 1:143 SMITH ST # 121
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-4345
Mailing Address - Country:US
Mailing Address - Phone:908-488-8003
Mailing Address - Fax:
Practice Address - Street 1:179 BRIGHTON AVE APT 1
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4778
Practice Address - Country:US
Practice Address - Phone:732-850-8631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17234300163W00000X, 171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No163W00000XNursing Service ProvidersRegistered Nurse