MEDICARE: MISS JAMIE JILL EBNOTHER FNP-BC

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	363LF0000X	Family Nurse Practitioner	866283	NV

General Provider Information

NPI Number	:	1114615168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JAMIE JILL EBNOTHER FNP-BC

Provider Business Mailing Address
First Line	:	2960 SUNRIDGE HEIGHTS PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4462
Country	:	US
Telephone Number	:	725-291-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 SUNRIDGE HEIGHTS PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4462
Country	:	US
Telephone Number	:	725-291-5900
Fax Number	:	725-291-5901

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

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	11/13/2024

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