Healthcare Provider Details

I. General information

NPI: 1295476653
Provider Name (Legal Business Name): PATSYLYNN JETLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATSYLYNN CEPEDA

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AKARI BUILDING
SAIPAN MP
96950
US

IV. Provider business mailing address

PMB 761 BOX 10003
SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-233-2668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4721
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0111
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: