Provider Demographics
NPI:1861877466
Name:SCAPARDINE, JACQUELINE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:SCAPARDINE
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 1:7530 COUNTY ROAD B
Mailing Address - Street 2:
Mailing Address - City:PITTSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54466-9759
Mailing Address - Country:US
Mailing Address - Phone:715-676-2920
Mailing Address - Fax:
Practice Address - Street 1:7530 COUNTY ROAD B
Practice Address - Street 2:
Practice Address - City:PITTSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54466-9759
Practice Address - Country:US
Practice Address - Phone:715-676-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI158332163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health