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General NPI Number Information
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NPI Number | 1205656816
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Entity Type | Individual
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Provider Name | JENNIELEE JAO MIA RN
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Gender | Female
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 1644 CENTRAL AVE
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City | MCKINLEYVILLE
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State | CA
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Zip | 95519-4342
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Country | US
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Telephone | 707-839-3068
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Fax | 707-839-3827
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Provider Business Mailing Address
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Address Line | 1275 8TH ST
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City | ARCATA
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State | CA
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Zip | 95521-5770
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Country | US
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Telephone | 707-826-8633
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Fax | 707-826-6838
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95393178
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License Number State | CA
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