Individual
JACQUELINE ELIZABETH VERCAUTEREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19555 N 59TH AVE, GLENDALE, AZ 85308-6813
(623) 572-3215
Mailing address
20401 N 73RD ST, STE 230, SCOTTSDALE, AZ 85255-4153
(480) 556-0446
(623) 209-7669
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8165
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/23/2020
Last updated
01/14/2021
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