Healthcare Provider Details

I. General information

NPI: 1750346037
Provider Name (Legal Business Name): JEANETTE RENEE VANARSDALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JEANETTE RENEE MEEK RN

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 166 INNER LOOP ROAD USA MEDDAC
FORT IRWIN CA
92310-5109
US

IV. Provider business mailing address

BUILDING 248A BOX 81
FORT IRWIN CA
92310-5109
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-6292
  • Fax:
Mailing address:
  • Phone: 760-267-5165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number17788
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: