Basic Information
| Provider Information | |||||||||
| NPI: | 1568000982 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEEN | ||||||||
| FirstName: | JACQUELYN | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSN, CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 KILBRECK DR | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275116340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194349535 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4551 NEW BERN AVE | ||||||||
| Address2: | STE 160 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195561008 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2019 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 201914081 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | 363LP0200X | 5012725 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.