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NPI Code Detail

MEDICARE: JACQUELYN NICOLE PAGH CRNA

MEDICARE: JACQUELYN NICOLE PAGH CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist95002669CA

General Provider Information

NPI Number : 1366015414
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN NICOLE PAGH CRNA
Provider Business Mailing Address
First Line : 3939 E VEST AVE APT 159
Second Line :
City : GILBERT
State : AZ
Zip : 85295-4694
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2615 CHESTER AVE
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93301-2014
Country : US
Telephone Number : 520-626-6154
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2021
Last Update Date : 12/15/2025

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