Provider Demographics
NPI:1588243943
Name:FOX, JACQUELYN ANNE (RN)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:ANNE
Last Name:FOX
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 1:5810 BLACKSHIRE PATH
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1857
Mailing Address - Country:US
Mailing Address - Phone:612-871-3700
Mailing Address - Fax:612-871-3705
Practice Address - Street 1:5810 BLACKSHIRE PATH
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1857
Practice Address - Country:US
Practice Address - Phone:612-871-3700
Practice Address - Fax:612-871-3705
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR2058607163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health