Healthcare Provider Details

I. General information

NPI: 1518384650
Provider Name (Legal Business Name): JENNIFER HAIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3182 E SUPERIOR RD
SAN TAN VALLEY AZ
85143-4576
US

IV. Provider business mailing address

3182 E SUPERIOR RD
SAN TAN VALLEY AZ
85143-4576
US

V. Phone/Fax

Practice location:
  • Phone: 602-790-8945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN183268
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: