Provider Demographics
NPI:1558636167
Name:NSA, JACQUELINE MADISON (CNA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MADISON
Last Name:NSA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 COOK RD
Mailing Address - Street 2:2110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-3975
Mailing Address - Country:US
Mailing Address - Phone:281-818-3772
Mailing Address - Fax:
Practice Address - Street 1:8000 COOK RD
Practice Address - Street 2:2110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-3975
Practice Address - Country:US
Practice Address - Phone:281-818-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
TXNA08767798374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide