Provider Demographics
NPI:1205946670
Name:HUNTER, JASCHON VAN
Entity type:Individual
Prefix:
First Name:JASCHON
Middle Name:VAN
Last Name:HUNTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7526 E BAKER DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-1895
Mailing Address - Country:US
Mailing Address - Phone:480-947-7747
Mailing Address - Fax:480-585-9667
Practice Address - Street 1:1800 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-2137
Practice Address - Country:US
Practice Address - Phone:480-947-7474
Practice Address - Fax:480-585-9667
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16337332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies