MEDICARE: JEANNA DESWERT

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	176B00000X	Midwife

General Provider Information

NPI Number	:	1134654734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNA DESWERT

Provider Business Mailing Address
First Line	:	1312 E RIO GRANDE AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-4815
Country	:	US
Telephone Number	:	707-416-9942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1312 E RIO GRANDE AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-4815
Country	:	US
Telephone Number	:	707-416-9942
Fax Number	:

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

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	04/21/2017

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Directions to “ JEANNA DESWERT ” Practice Location

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