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General NPI Number Information
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NPI Number | 1447928486
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Entity Type | Individual
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Provider Name | JADE MARIE CEDENO MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 3950 NEWMAN RD
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City | JOPLIN
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State | MO
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Zip | 64801-1512
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Country | US
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Telephone | 417-625-3156
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 S HILLCREST AVE APT B302
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City | SPRINGFIELD
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State | MO
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Zip | 65807-5615
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Country | US
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Telephone | 951-526-3594
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2021034192
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License Number State | MO
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