Individual
JACEY B MAULE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
241 CORPORATE BLVD STE 210, NORFOLK, VA 23502-4965
(757) 622-2200
Mailing address
700 HAWES CT APT C, RALEIGH, NC 27608-1745
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
257016
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011008172
VA MEDICAL LICENSE
VA
Enumeration date
01/24/2020
Last updated
09/19/2024
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