MEDICARE: JODI LYNN FENNELL NBHWC

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	171400000X	Health & Wellness Coach	820212926	NV
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1063768273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI LYNN FENNELL NBHWC

Provider Business Mailing Address
First Line	:	PO BOX 2743
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89702-2743
Country	:	US
Telephone Number	:	775-293-8669
Fax Number	:

Provider Business Practice Location Address
First Line	:	10345 PROFESSIONAL CIR STE 125
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89521-3100
Country	:	US
Telephone Number	:	775-332-8332
Fax Number	:

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

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	01/06/2025

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