MEDICARE: MS. JEANETTE RENEE VANARSDALL 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	163WC0200X	Critical Care Medicine Registered Nurse	17788	AK

General Provider Information

NPI Number	:	1750346037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANETTE RENEE VANARSDALL RN

Provider Business Mailing Address
First Line	:	BUILDING 248A BOX 81
Second Line	:
City	:	FORT IRWIN
State	:	CA
Zip	:	92310-5109
Country	:	US
Telephone Number	:	760-267-5165
Fax Number	:

Provider Business Practice Location Address
First Line	:	BUILDING 166 INNER LOOP ROAD
Second Line	:	USA MEDDAC
City	:	FORT IRWIN
State	:	CA
Zip	:	92310-5109
Country	:	US
Telephone Number	:	760-380-6292
Fax Number	:

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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