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NPI Code Detail

MEDICARE: NICHOLLE JENNINGS MSW

MEDICARE:   NICHOLLE  JENNINGS  MSW
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
1390200000XStudent in an Organized Health Care Education/Training Program
21041C0700XClinical Social Worker83421CA

General Provider Information

NPI Number : 1417208133
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLLE JENNINGS MSW
Provider Business Mailing Address
First Line : 4900 CALIFORNIA AVE STE 400B
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-7081
Country : US
Telephone Number : 661-630-7048
Fax Number : 661-869-1503
Provider Business Practice Location Address
First Line : 4900 CALIFORNIA AVE STE. 400B
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-7081
Country : US
Telephone Number : 661-459-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2012
Last Update Date : 04/26/2019

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