Provider Demographics
NPI:1659244606
Name:UNDERWWOD, JACQUELINE
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:UNDERWWOD
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 1:3609 TERTULIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6654
Mailing Address - Country:US
Mailing Address - Phone:510-277-2701
Mailing Address - Fax:
Practice Address - Street 1:1820 E SAHARA AVE STE 114
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3736
Practice Address - Country:US
Practice Address - Phone:702-262-1202
Practice Address - Fax:702-749-6232
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant