Provider Demographics
NPI:1972153500
Name:BOIS, JACQUELINE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BOIS
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 1:1901 BRINTONS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7088
Mailing Address - Country:US
Mailing Address - Phone:610-793-3310
Mailing Address - Fax:610-793-3649
Practice Address - Street 1:627 SWANSEA DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-0202
Practice Address - Country:US
Practice Address - Phone:484-320-0167
Practice Address - Fax:610-793-3649
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0053019163WP0808X
PARN533833163WP0808X
DEL8-0010333363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty