Basic Information
| Provider Information | |||||||||
| NPI: | 1659677748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29039 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850389039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022562525 | ||||||||
| FaxNumber: | 6022560795 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 N CENTRAL AVE | ||||||||
| Address2: | STE 2550 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022562525 | ||||||||
| FaxNumber: | 6022560795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2011 | ||||||||
| LastUpdateDate: | 07/29/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | AP5073 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.