MEDICARE: JENNIFER DAWSON D'ANDREA 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	363L00000X	Nurse Practitioner	AP60591634	WA
2	363LP2300X	Primary Care Nurse Practitioner	AP60591634	WA
3	363LF0000X	Family Nurse Practitioner	816422	NV
4	363LF0000X	Family Nurse Practitioner	F0715892	WA

General Provider Information

NPI Number	:	1386029163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DAWSON D'ANDREA APRN

Provider Business Mailing Address
First Line	:	2779 W HORIZON RIDGE PKWY STE 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4186
Country	:	US
Telephone Number	:	702-990-2290
Fax Number	:

Provider Business Practice Location Address
First Line	:	2779 W HORIZON RIDGE PKWY STE 200
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4186
Country	:	US
Telephone Number	:	702-990-2290
Fax Number	:

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

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	05/03/2022

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