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NPI Code Detail

MEDICARE: JENNIFER DAWN HERMANCE

MEDICARE: JENNIFER DAWN HERMANCE
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
1106S00000XBehavior TechnicianNV

General Provider Information

NPI Number : 1184998684
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER DAWN HERMANCE
Provider Business Mailing Address
First Line : 2050 S MAGIC WAY SPC 63
Second Line :
City : HENDERSON
State : NV
Zip : 89002-8631
Country : US
Telephone Number : 805-813-5500
Fax Number :
Provider Business Practice Location Address
First Line : 2801 S VALLEY VIEW BLVD STE 6
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-0166
Country : US
Telephone Number : 702-922-7015
Fax Number : 702-922-6600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2012
Last Update Date : 11/04/2025

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