Healthcare Provider Details

I. General information

NPI: 1285488346
Provider Name (Legal Business Name): JERO MULTISPECIALTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 CHASE TREE ST
LAS VEGAS NV
89144-4502
US

IV. Provider business mailing address

624 CHASE TREE ST
LAS VEGAS NV
89144-4502
US

V. Phone/Fax

Practice location:
  • Phone: 702-556-3671
  • Fax:
Mailing address:
  • Phone: 702-556-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARICELJEAN RYCRAFT
Title or Position: ADMINISTRATOR
Credential:
Phone: 725-232-8649