Healthcare Provider Details

I. General information

NPI: 1164646063
Provider Name (Legal Business Name): JEANETTE DAY JICHA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 W SEED FARM RD
SACATON AZ
85147-5000
US

IV. Provider business mailing address

PO BOX 38
SACATON AZ
85147-0001
US

V. Phone/Fax

Practice location:
  • Phone: 602-528-1200
  • Fax: 602-528-1255
Mailing address:
  • Phone: 602-528-1200
  • Fax: 602-528-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3761
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: