Healthcare Provider Details

I. General information

NPI: 1356565873
Provider Name (Legal Business Name): JACQUELYN JACKSON DUARTE RN, BSN, MPA, M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 W ALAMEDA RD
GLENDALE AZ
85310-3601
US

IV. Provider business mailing address

5805 W ALAMEDA RD
GLENDALE AZ
85310-3601
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-5510
  • Fax: 623-445-5580
Mailing address:
  • Phone: 623-445-5510
  • Fax: 623-445-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN043729
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: