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General NPI Number Information
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NPI Number | 1053812362
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Entity Type | Individual
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Provider Name | JACQUELINE CLUBINE CNM
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Gender | Female
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 433 E 8TH ST
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City | PORT ANGELES
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State | WA
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Zip | 98362-6219
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Country | US
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Telephone | 360-565-0999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 850
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City | PORT ANGELES
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State | WA
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Zip | 98362-0146
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Country | US
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Telephone | 360-565-0999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | RN261851
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | AP61546588
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61546589
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License Number State | WA
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