Healthcare Provider Details

I. General information

NPI: 1841128386
Provider Name (Legal Business Name): ANDREA LYNN JEWETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 E WARNER RD STE 206
GILBERT AZ
85296-3066
US

IV. Provider business mailing address

3118 W SILVER CREEK DR
SAN TAN VALLEY AZ
85144-6095
US

V. Phone/Fax

Practice location:
  • Phone: 480-331-2201
  • Fax: 480-800-4944
Mailing address:
  • Phone: 520-402-7881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number246163
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: