Provider Demographics
NPI:1992062467
Name:LAGUERRE, JACQUELINE BRUTUS (RN)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:BRUTUS
Last Name:LAGUERRE
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 1:183 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1753
Mailing Address - Country:US
Mailing Address - Phone:845-459-5674
Mailing Address - Fax:
Practice Address - Street 1:183 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1753
Practice Address - Country:US
Practice Address - Phone:845-459-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY416289163WH0200X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult