Individual
MRS. JENNIFER ANN DAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2901 86TH ST, URBANDALE, IA 50322-4204
(515) 276-3406
(515) 278-2377
Mailing address
2901 86TH ST, URBANDALE, IA 50322-4204
(515) 276-3406
(515) 278-2377
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
078992
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078992
IOWA LICENSE
IA
Enumeration date
07/10/2015
Last updated
07/26/2019
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