Provider Demographics
NPI:1679723753
Name:YADEN, JACQUELINE D (LVN)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:D
Last Name:YADEN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:D
Other - Last Name:YADEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:1537 FISK ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4430
Mailing Address - Country:US
Mailing Address - Phone:806-367-6446
Mailing Address - Fax:
Practice Address - Street 1:1537 FISK ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4430
Practice Address - Country:US
Practice Address - Phone:806-367-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151175164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse