Provider Demographics
NPI:1568000982
Name:STEEN, JACQUELYN MARIA (MSN, CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:MARIA
Last Name:STEEN
Suffix:
Gender:F
Credentials:MSN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 KILBRECK DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6340
Mailing Address - Country:US
Mailing Address - Phone:919-434-9535
Mailing Address - Fax:
Practice Address - Street 1:4551 NEW BERN AVE
Practice Address - Street 2:STE 160
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:919-556-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201914081208000000X
NC5012725363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics