Healthcare Provider Details

I. General information

NPI: 1538886544
Provider Name (Legal Business Name): JACQULLINE ANN HITCHCOCK LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 LEO LN
WASHINGTON WV
26181-8466
US

IV. Provider business mailing address

1234 PUTNAM HOWE DR
BELPRE OH
45714-2226
US

V. Phone/Fax

Practice location:
  • Phone: 740-371-0731
  • Fax:
Mailing address:
  • Phone: 740-371-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number27293
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: