Healthcare Provider Details

I. General information

NPI: 1841284056
Provider Name (Legal Business Name): JEANINE GAIL STETTLER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 11TH ST
HILL AFB UT
84056-5012
US

IV. Provider business mailing address

7561 S 2050 E
SOUTH WEBER UT
84405-9646
US

V. Phone/Fax

Practice location:
  • Phone: 801-777-7109
  • Fax: 777-586-4018
Mailing address:
  • Phone: 801-476-4508
  • Fax: 801-586-4018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN00120703
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: