MEDICARE: JENNIFER TENEIL SCRIVEN UDEKIGBO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1073323002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER TENEIL SCRIVEN UDEKIGBO

Provider Business Mailing Address
First Line	:	601 GROVES BLVD
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-3956
Country	:	US
Telephone Number	:	803-508-2401
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 GROVES BLVD
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-3956
Country	:	US
Telephone Number	:	803-508-2401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2025
Last Update Date	:	01/11/2025

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Directions to “ JENNIFER TENEIL SCRIVEN UDEKIGBO ” Practice Location

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