Healthcare Provider Details

I. General information

NPI: 1487119160
Provider Name (Legal Business Name): JERI LYNN BJARKO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 N ELLSWORTH RD STE 108
MESA AZ
85207-5144
US

IV. Provider business mailing address

261 N ROOSEVELT AVE
CHANDLER AZ
85226-2616
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-8282
  • Fax:
Mailing address:
  • Phone: 480-305-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number158388
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225151
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: