Provider Demographics
NPI:1750346037
Name:VANARSDALL, JEANETTE RENEE (RN)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:RENEE
Last Name:VANARSDALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JEANETTE
Other - Middle Name:RENEE
Other - Last Name:MEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:BUILDING 248A BOX 81
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-5109
Mailing Address - Country:US
Mailing Address - Phone:760-267-5165
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 166 INNER LOOP ROAD
Practice Address - Street 2:USA MEDDAC
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-5109
Practice Address - Country:US
Practice Address - Phone:760-380-6292
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK17788163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine