Healthcare Provider Details

I. General information

NPI: 1376407353
Provider Name (Legal Business Name): PAUL JEWETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 E PECOS RD APT 1002
GILBERT AZ
85295-7837
US

IV. Provider business mailing address

4255 E PECOS RD APT 1002
GILBERT AZ
85295-7837
US

V. Phone/Fax

Practice location:
  • Phone: 480-694-0841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number302407
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: