Healthcare Provider Details

I. General information

NPI: 1467095059
Provider Name (Legal Business Name): JESSICA VUE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 04/17/2022
Certification Date: 04/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUNRISE AVE
ROSEVILLE CA
95661-4502
US

IV. Provider business mailing address

5623 VERNER OAK CT
SACRAMENTO CA
95841-2039
US

V. Phone/Fax

Practice location:
  • Phone: 916-772-6337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: