Healthcare Provider Details

I. General information

NPI: 1588109250
Provider Name (Legal Business Name): JACLYN FAESTEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN STEPHANY HOOD

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CTR 9040 JACKSON AVE, ATTN: MCHJ-CLQ-C
TACOMA WA
98431-1100
US

IV. Provider business mailing address

6222 GRAND FIR DR SW
MCCHORD AFB WA
98439-2200
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-3869
  • Fax:
Mailing address:
  • Phone: 808-284-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number664512-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: