MEDICARE: JENNY RAND ANDERSON

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	374J00000X	Doula

General Provider Information

NPI Number	:	1083191175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY RAND ANDERSON

Provider Business Mailing Address
First Line	:	PO BOX 6982
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97708-6982
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	63275 OVERTREE RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-9759
Country	:	US
Telephone Number	:	805-390-9052
Fax Number	:

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

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	07/23/2018

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Directions to “ JENNY RAND ANDERSON ” Practice Location

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