Provider Demographics
NPI:1992969638
Name:ANDULA, JACQUELYN MARIE (MPH, RN)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:MARIE
Last Name:ANDULA
Suffix:
Gender:F
Credentials:MPH, RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:95 FRANKLIN ST
Mailing Address - Street 2:RM. 925
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-3925
Mailing Address - Country:US
Mailing Address - Phone:716-858-7731
Mailing Address - Fax:716-858-8701
Practice Address - Street 1:95 FRANKLIN ST
Practice Address - Street 2:RM. 925
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3925
Practice Address - Country:US
Practice Address - Phone:716-858-7731
Practice Address - Fax:716-858-8701
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY424856-1163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator