MEDICARE: JERI LYNN BJARKO RN

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	163WX0002X	High-Risk Obstetric Registered Nurse	158388	AZ
2	363LF0000X	Family Nurse Practitioner	225151	AZ

General Provider Information

NPI Number	:	1487119160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERI LYNN BJARKO RN

Provider Business Mailing Address
First Line	:	261 N ROOSEVELT AVE
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2616
Country	:	US
Telephone Number	:	480-305-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 N ELLSWORTH RD STE 108
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-5144
Country	:	US
Telephone Number	:	480-677-8282
Fax Number	:

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

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	04/28/2021

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