Provider Demographics
NPI:1720973878
Name:GUTHRIE, JACKELINE
Entity type:Individual
Prefix:MRS
First Name:JACKELINE
Middle Name:
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HERITAGE DR APT A
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5325
Mailing Address - Country:US
Mailing Address - Phone:201-723-1572
Mailing Address - Fax:
Practice Address - Street 1:84 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1831
Practice Address - Country:US
Practice Address - Phone:844-400-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347070164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse