MEDICARE: JERICA DEAN

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1093447104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERICA DEAN

Provider Business Mailing Address
First Line	:	2349 CADIE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3328
Country	:	US
Telephone Number	:	937-901-5282
Fax Number	:

Provider Business Practice Location Address
First Line	:	2349 CADIE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3328
Country	:	US
Telephone Number	:	937-901-5282
Fax Number	:

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

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/28/2022

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Directions to “ JERICA DEAN ” Practice Location

Language	Start Address	Practice Location

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