Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | AP11203 | AZ |
N | 363LC1500X | Nurse Practitioner - Community Health | AP11203 | AZ |
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP11203 | AZ |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP11203 | AZ |
NPI | 1700373107 |
---|---|
Provider Name | Jacqleen Jaana Stetson |
First Address | Chandler, AZ 85225-5498 |
Second Address | Scottsdale, AZ 85260-2717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2018 |
Last Update Date | 06/10/2021 |