MEDICARE: RHONDA JACKSON TEACHER

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	174H00000X	Health Educator	174H00000X	VA

General Provider Information

NPI Number	:	1538556188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA JACKSON TEACHER

Provider Business Mailing Address
First Line	:	2404 SPENCER RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 SPENCER RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2322
Country	:	US
Telephone Number	:	301-412-1022
Fax Number	:	301-412-1022

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

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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