Dewalt, Jaclyn Marie
Dewalt, Jaclyn Marie is an individual health care provider with primary practice located at 15290 Pennock Ln , Apple Valley MN 55124-7163. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Dewalt, Jaclyn Marie can be contacted via phone (952) 431-8500.Contact Information
Primary practice address
15290 Pennock Ln
Apple Valley MN 55124-7163
Phone: (952) 431-8500
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | Minnesota |
Profile Details
| NPI number | 1912194291 |
|---|---|
| LBN Legal business name | Dewalt, Jaclyn Marie |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 1st, 2007 |
| Last updated | Dec 5th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912194291 | NPPES |
| Minnesota | MEDICAID | 475488000 |
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