MEDICARE: JEANNINE ARNETTA NASH

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1417557653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNINE ARNETTA NASH

Provider Business Mailing Address
First Line	:	7614 LEMON AVE STE C
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1619
Country	:	US
Telephone Number	:	619-678-1210
Fax Number	:

Provider Business Practice Location Address
First Line	:	7614 LEMON AVE STE C
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-1619
Country	:	US
Telephone Number	:	619-678-1210
Fax Number	:	619-872-2485

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

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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