Provider Demographics
NPI:1306650353
Name:MOONEY, JACQUELINE R (RN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:R
Last Name:MOONEY
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 1:91 HOLMES OVAL
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1466
Mailing Address - Country:US
Mailing Address - Phone:908-499-8522
Mailing Address - Fax:
Practice Address - Street 1:91 HOLMES OVAL
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1466
Practice Address - Country:US
Practice Address - Phone:908-499-8522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14391300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty