Healthcare Provider Details

I. General information

NPI: 1699681858
Provider Name (Legal Business Name): MARIE A JACQUES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 COOKS ALY
SICKLERVILLE NJ
08081-5631
US

IV. Provider business mailing address

14 COOKS ALY
SICKLERVILLE NJ
08081-5631
US

V. Phone/Fax

Practice location:
  • Phone: 609-854-1584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26NP49898700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: