Individual
JACQUELYNN Y SHOWALTER-ETSITTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
HWY 160/163 BUILDING KA 2010, KAYENTA, AZ 86033-0368
(928) 697-4000
Mailing address
PO BOX 368, KAYENTA, AZ 86033-0368
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
162,593
AZ
163WE0003X
Emergency Registered Nurse
RN 162,593
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060012
—
AZ
Enumeration date
01/17/2013
Last updated
01/17/2013
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