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General NPI Number Information
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NPI Number | 1063768273
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Entity Type | Individual
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Provider Name | JODI LYNN FENNELL NBHWC
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Gender | Female
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 10345 PROFESSIONAL CIR STE 125
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City | RENO
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State | NV
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Zip | 89521-3100
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Country | US
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Telephone | 775-332-8332
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2743
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City | CARSON CITY
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State | NV
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Zip | 89702-2743
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Country | US
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Telephone | 775-293-8669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | 820212926
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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