Provider Demographics
NPI:1538886544
Name:HITCHCOCK, JACQULLINE ANN (LPN)
Entity type:Individual
Prefix:
First Name:JACQULLINE
Middle Name:ANN
Last Name:HITCHCOCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 PUTNAM HOWE DR
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-2226
Mailing Address - Country:US
Mailing Address - Phone:740-371-0731
Mailing Address - Fax:
Practice Address - Street 1:153 LEO LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:WV
Practice Address - Zip Code:26181-8466
Practice Address - Country:US
Practice Address - Phone:740-371-0731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27293202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
630435OtherWORKMANS COMP
WV630435Medicaid