Provider Demographics
NPI:1790666279
Name:TOKU-DUM, JACQUELINE L
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:TOKU-DUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 HAYSTACK AVE
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7367
Mailing Address - Country:US
Mailing Address - Phone:614-209-4077
Mailing Address - Fax:
Practice Address - Street 1:263 HAYSTACK AVE
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7367
Practice Address - Country:US
Practice Address - Phone:614-209-4077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.450263163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health