MEDICARE: MRS. JESSICA MARIE SANCHEZ APRN

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	363LF0000X	Family Nurse Practitioner	F03170461	OH

General Provider Information

NPI Number	:	1336641711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA MARIE SANCHEZ APRN

Provider Business Mailing Address
First Line	:	617 SHROYER RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-4055
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	617 SHROYER RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-4055
Country	:	US
Telephone Number	:	937-768-5806
Fax Number	:

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

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	03/22/2018

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