=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043626427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JACQUELINE F. SAUDER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2014
-----------------------------------------------------
Last Update Date | 07/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5704 FREEPORT CT
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43081-5231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-308-4638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5704 FREEPORT CT
-----------------------------------------------------
City | WESTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43081-5231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-308-4638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE
-----------------------------------------------------
Name | MS. JACQUELINE FAY SAUDER
-----------------------------------------------------
Credential | R.N .
-----------------------------------------------------
Telephone | 310-308-4638
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 198308
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------