Provider Demographics
NPI:1811165939
Name:MAHER, JACKIE ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:ANN
Last Name:MAHER
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 1:38610 GREEN MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8326
Mailing Address - Country:US
Mailing Address - Phone:951-818-6523
Mailing Address - Fax:
Practice Address - Street 1:30755 AULD RD STE B
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2581
Practice Address - Country:US
Practice Address - Phone:951-696-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN425912163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult