Provider Demographics
NPI:1154164655
Name:MCGRATH, JACQUELINE M (PHD, RN FAAN)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:M
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:PHD, RN FAAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 S 42ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3917
Mailing Address - Country:US
Mailing Address - Phone:804-754-6278
Mailing Address - Fax:
Practice Address - Street 1:13001 S 42ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-3917
Practice Address - Country:US
Practice Address - Phone:804-754-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN069690163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care