Provider Demographics
NPI:1467128306
Name:VEATER, JACOB DAVID (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:DAVID
Last Name:VEATER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 E GABLE CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6321
Mailing Address - Country:US
Mailing Address - Phone:480-650-1537
Mailing Address - Fax:
Practice Address - Street 1:3112 E GABLE CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6321
Practice Address - Country:US
Practice Address - Phone:480-650-1537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN177862163W00000X
AZ268565367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse