Healthcare Provider Details

I. General information

NPI: 1942314901
Provider Name (Legal Business Name): JENNIFER LYNN MCAULEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE NEONATOLOGY DEPT
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

21090 TULITA CT
CUPERTINO CA
95014-1639
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5255
  • Fax:
Mailing address:
  • Phone: 408-499-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN494476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: