Henderson, Jacquelynn Dian

Henderson, Jacquelynn Dian is an individual health care provider with primary practice located at 4800 N 22Nd St , Phoenix AZ 85016-4701. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Henderson, Jacquelynn Dian can be contacted via phone (602) 955-1000.

Contact Information

Primary practice address
4800 N 22Nd St Phoenix AZ 85016-4701
Phone: (602) 955-1000
Fax: (602) 508-4830
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA13970 California
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 5994 Arizona

Profile Details

NPI number 1003875253
LBN Legal business name Henderson, Jacquelynn Dian
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 17th, 2006
Last updated Jan 11th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003875253 NPPES
Arizona Other Z181353 MEDICARE PTAN

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