Provider Demographics
NPI:1730712035
Name:ARDUINI, JACLYN
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:ARDUINI
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 1:3569 SCOTT ROAD
Mailing Address - Street 2:
Mailing Address - City:KELOWNA
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V1W3H5
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6775 EDMOND ST STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3502
Practice Address - Country:US
Practice Address - Phone:702-330-6152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05064212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer