MEDICARE: ANN LOUISE JAMBOR FNTP, MRWP

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1326823139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN LOUISE JAMBOR FNTP, MRWP

Provider Business Mailing Address
First Line	:	6635 SILVER SADDLE RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76126-9597
Country	:	US
Telephone Number	:	817-269-9463
Fax Number	:

Provider Business Practice Location Address
First Line	:	5925 LOVELL AVE STE B
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5062
Country	:	US
Telephone Number	:	682-499-5603
Fax Number	:

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

Provider Enumeration Date	:	08/29/2023
Last Update Date	:	08/29/2023

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