Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | NP9805 | CA |
N | 363L00000X | Nurse Practitioner | RN138280 | AZ |
N | 363L00000X | Nurse Practitioner | RN363330 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP2369 | AZ |
NPI | 1023039575 |
---|---|
Provider Name | Jennifer Mae Prescott |
First Address | Carefree, AZ 85377-6094 |
Second Address | Goodyear, AZ 85338-1226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 02/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023039575 | (05) | CA |
352307 | (05) | AZ |
RN363330 | (05) | CA |