MEDICARE: JENNIFER CLOUD

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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	R141740-1	MN

General Provider Information

NPI Number	:	1861149726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CLOUD

Provider Business Mailing Address
First Line	:	22435 CALICO CT
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-4009
Country	:	US
Telephone Number	:	952-905-9166
Fax Number	:

Provider Business Practice Location Address
First Line	:	22435 CALICO CT
Second Line	:
City	:	FARMINGTON
State	:	MN
Zip	:	55024-4009
Country	:	US
Telephone Number	:	952-905-9166
Fax Number	:

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

Provider Enumeration Date	:	03/09/2022
Last Update Date	:	03/09/2022

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