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NPI Code Detail

MEDICARE: JASMYNE NANCE RBT

MEDICARE: JASMYNE NANCE RBT
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 TechnicianRBT-22-236293CO

General Provider Information

NPI Number : 1275088106
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMYNE NANCE RBT
Provider Business Mailing Address
First Line : 104 W OLD BROADMOOR RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-3336
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4815 LIST DR STE 107
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80919-3340
Country : US
Telephone Number : 719-325-6311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2016
Last Update Date : 10/04/2022

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Directions to “ JASMYNE NANCE RBT” Practice Location

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