MEDICARE: ELIZABETH NICOLE JESTER

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	164X00000X	Licensed Vocational Nurse	1013949	TX

General Provider Information

NPI Number	:	1174118376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH NICOLE JESTER

Provider Business Mailing Address
First Line	:	3235 RUCKMAN ST UNIT A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-4232
Country	:	US
Telephone Number	:	915-479-7602
Fax Number	:

Provider Business Practice Location Address
First Line	:	3235 RUCKMAN ST UNIT A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79904-4232
Country	:	US
Telephone Number	:	915-479-7602
Fax Number	:

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

Provider Enumeration Date	:	03/09/2021
Last Update Date	:	03/09/2021

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Directions to “ ELIZABETH NICOLE JESTER ” Practice Location

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