Jaclyn Marie Dewalt in Apple Valley - Medical
Jaclyn Marie Dewalt - NPI 1912194291
Jaclyn Marie Dewalt is a Medical in Apple Valley, Minnesota. Jaclyn Marie Dewalt practices all healthcare services and medical treatments related to Medical. The NPI Number for Jaclyn Marie Dewalt is 1912194291. The last update date is 2011-12-05.
Jaclyn Marie Dewalt's current location address is 15290 Pennock Ln, Apple Valley, Minnesota. You can contact this provider via phone number 9524318500. The mailing address for Jaclyn Marie Dewalt is 15290 Pennock Ln, Apple Valley, Minnesota. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jaclyn Marie Dewalt |
|---|---|
| Address | 15290 Pennock Ln, Apple Valley, Minnesota |
| Phone Number | 9524318500 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | PA-C |
NPI Number Detail
| NPI Number | 1912194291 |
|---|---|
| Provider Enumeration Date | 2007-10-01 |
| Last Updated Date | 2011-12-05 |
Provider Mailing Address Detail
| Address | 15290 Pennock Ln |
|---|---|
| City | Apple Valley |
| State | Minnesota (MN) |
| Post Code | 551247163 |
| Phone Number | 9524318500 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Medical |
|---|---|
| Taxonomy | 363Am0700X |
|
Definition: A licensed healthcare professional who practices medicine under physician supervision focusing on medical diagnoses and treatment. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 475488000 | MN | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Jaclyn Marie Dewalt by the Centers for Medicare & Medicaid Services?
The Jaclyn Marie Dewalt has been assigned the NPI (National Provider Identifier) 1912194291. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete street address where Jaclyn Marie Dewalt is physically located?
The Jaclyn Marie Dewalt is physically situated at the following address: 15290 Pennock Ln, Apple Valley, MN, 551247163.
What is Jaclyn Marie Dewalt's specialized field of practice, and what is the corresponding taxonomy classification code?
The Jaclyn Marie Dewalt's area of specialization is Medical, and the corresponding taxonomy code that categorizes this field of practice is 363Am0700X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1912194291 to Jaclyn Marie Dewalt?
The Centers for Medicare & Medicaid Services originally issued the 1912194291 to Jaclyn Marie Dewalt on 2007-10-01.
When was the information regarding Jaclyn Marie Dewalt most recently updated?
The details pertaining to the Jaclyn Marie Dewalt, including its address, specialty, and other relevant information, were last refreshed on 2011-12-05.