Healthcare Provider Details

I. General information

NPI: 1982276192
Provider Name (Legal Business Name): JADE ENOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JADE VERNAU

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 10/08/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SPRINGFIELD DR
CHICO CA
95928-5995
US

IV. Provider business mailing address

1515 SPRINGFIELD DR STE 175
CHICO CA
95928-5398
US

V. Phone/Fax

Practice location:
  • Phone: 530-781-1440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017498
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: