Provider Demographics
NPI:1619539186
Name:VERKUYL, JENNIE ANNETTE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:ANNETTE MARIE
Last Name:VERKUYL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:ANNETTE MARIE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4175 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-9615
Mailing Address - Country:US
Mailing Address - Phone:775-771-7989
Mailing Address - Fax:
Practice Address - Street 1:75 PRINGLE WAY STE 804
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-8400
Practice Address - Country:US
Practice Address - Phone:775-227-5904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2335363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical