MEDICARE: TRENICE JUPITER

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	343900000X	Non-emergency Medical Transport (VAN)	008063360	LA

General Provider Information

NPI Number	:	1306294467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENICE JUPITER

Provider Business Mailing Address
First Line	:	13121 CARRERE CT
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70129-2227
Country	:	US
Telephone Number	:	504-662-0261
Fax Number	:	504-662-0263

Provider Business Practice Location Address
First Line	:	13121 CARRERE CT
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70129-2227
Country	:	US
Telephone Number	:	504-662-0261
Fax Number	:	504-662-0263

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

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	05/31/2016

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Directions to “ TRENICE JUPITER ” Practice Location

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