Provider Demographics
NPI:1851858328
Name:ECCLESTON, JEWEL (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JEWEL
Middle Name:
Last Name:ECCLESTON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7968 ALMEDA CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2363
Mailing Address - Country:US
Mailing Address - Phone:210-912-5825
Mailing Address - Fax:
Practice Address - Street 1:7968 ALMEDA CT
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-2363
Practice Address - Country:US
Practice Address - Phone:210-912-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2023-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001256418163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse