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NPI Code Detail

MEDICARE: KENNA JESKE RN

MEDICARE: KENNA JESKE RN
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
1163WC0400XCase Management Registered Nurse675850CA

General Provider Information

NPI Number : 1407489115
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNA JESKE RN
Provider Business Mailing Address
First Line : 1435 RIVER PARK DR STE 200
Second Line :
City : SACRAMENTO
State : CA
Zip : 95815-4510
Country : US
Telephone Number : 916-643-7155
Fax Number : 916-643-7155
Provider Business Practice Location Address
First Line : 1435 RIVER PARK DR STE 200
Second Line :
City : SACRAMENTO
State : CA
Zip : 95815-4510
Country : US
Telephone Number : 916-643-7155
Fax Number : 916-643-7155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2020
Last Update Date : 02/20/2020

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