MEDICARE: JESSICA MARY REHO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WN0002X	Neonatal Intensive Care Registered Nurse	682119-1	NY

General Provider Information

NPI Number	:	1033759162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARY REHO RN

Provider Business Mailing Address
First Line	:	25 STRATHALLAN PARK APT 5
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-1534
Country	:	US
Telephone Number	:	585-613-5475
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 STRATHALLAN PARK APT 5
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-1534
Country	:	US
Telephone Number	:	585-613-5475
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	01/07/2020

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