Individual
JACLYN MARIE SIVERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1675 E MELROSE ST STE 101-103, GILBERT, AZ 85297-1001
(602) 648-5444
(602) 772-3801
Mailing address
PO BOX 80217, PHOENIX, AZ 85060-0217
(602) 385-2115
(602) 772-3804
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
7674
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7674
STATE OF ARIZONA
AZ
Enumeration date
12/27/2019
Last updated
11/08/2022
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