Individual
JACQUELINE SUE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
6007 E BASELINE RD STE 101, MESA, AZ 85206-4801
(480) 833-3698
Mailing address
4121 N EL SERENO CIR, MESA, AZ 85207-7260
(480) 200-7110
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN186293
AZ
Other
Enumeration date
12/10/2017
Last updated
12/10/2017
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