Healthcare Provider Details

I. General information

NPI: 1790118750
Provider Name (Legal Business Name): JENNIFER ELIZABETH AITCHESON MAOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 NW 44TH ST
LAUDERHILL FL
33319-6168
US

IV. Provider business mailing address

1265 NW 12TH AVE.
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 954-610-5169
  • Fax:
Mailing address:
  • Phone: 305-547-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: