MEDICARE: DR. JACQUELINE STOCKING PHD, MBA, MSN, RN

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
1	163W00000X	Registered Nurse	484315	CA

General Provider Information

NPI Number	:	1407450448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE STOCKING PHD, MBA, MSN, RN

Provider Business Mailing Address
First Line	:	3434 JACKS VALLEY RD
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89705-7017
Country	:	US
Telephone Number	:	916-865-6008
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 JACKS VALLEY RD
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89705-7017
Country	:	US
Telephone Number	:	916-865-6008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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