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General NPI Number Information
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NPI Number | 1992514145
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Entity Type | Individual
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Provider Name | ADRA JAEHNIG
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Gender | Female
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 9620 N METRO PKWY W STE 143
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City | PHOENIX
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State | AZ
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Zip | 85051-1441
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Country | US
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Telephone | 623-295-4905
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Fax |
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Provider Business Mailing Address
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Address Line | 20325 N. 51ST AVE. BLDG 8 STE. 160
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City | GLENDALE
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State | AZ
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Zip | 85308-4622
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Country | US
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Telephone | 623-466-6350
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 226306
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License Number State | AZ
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