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General NPI Number Information
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NPI Number | 1346047339
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Entity Type | Individual
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Provider Name | JADE MARIE VINATIERI FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 2091 SMOKETREE AVE N STE 103
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5896
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Country | US
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Telephone | 928-453-3332
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 N VALLE DORADO
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City | KINGMAN
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State | AZ
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Zip | 86409-1599
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Country | US
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Telephone | 928-530-9783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 267114
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License Number State | AZ
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