MEDICARE: JENNIFER MOLESWORTH

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1285784827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MOLESWORTH

Provider Business Mailing Address
First Line	:	5592 POINTE DR
Second Line	:
City	:	EAST CHINA
State	:	MI
Zip	:	48054-4168
Country	:	US
Telephone Number	:	810-388-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	934 BRUCE ST
Second Line	:
City	:	MARINE CITY
State	:	MI
Zip	:	48039-1751
Country	:	US
Telephone Number	:	810-388-1200
Fax Number	:

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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Directions to “ JENNIFER MOLESWORTH ” Practice Location

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