MEDICARE: JADE MARIE PASSAMONTE

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	374J00000X	Doula

General Provider Information

NPI Number	:	1407686025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE MARIE PASSAMONTE

Provider Business Mailing Address
First Line	:	8092 N 16TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5419
Country	:	US
Telephone Number	:	480-772-3816
Fax Number	:

Provider Business Practice Location Address
First Line	:	8092 N 16TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5419
Country	:	US
Telephone Number	:	480-772-3816
Fax Number	:

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

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	08/07/2024

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Directions to “ JADE MARIE PASSAMONTE ” Practice Location

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