MEDICARE: JACQUELINE HOSEA

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1356546444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE HOSEA

Provider Business Mailing Address
First Line	:	308 EASTERN AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 EASTERN AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3258
Country	:	US
Telephone Number	:	317-357-0479
Fax Number	:

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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Directions to “ JACQUELINE HOSEA ” Practice Location

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