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NPI Code Detail

MEDICARE: JESSICA RANAE MATHEWS

MEDICARE:   JESSICA RANAE MATHEWS
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

General Provider Information

NPI Number : 1427729177
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA RANAE MATHEWS
Provider Business Mailing Address
First Line : 1963 E PRATER WAY STE 101
Second Line :
City : SPARKS
State : NV
Zip : 89434-8938
Country : US
Telephone Number : 775-636-6269
Fax Number : 775-686-6526
Provider Business Practice Location Address
First Line : 5540 SUN VISTA CT
Second Line :
City : SUN VALLEY
State : NV
Zip : 89433-7554
Country : US
Telephone Number : 775-219-4566
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2021
Last Update Date : 09/22/2021

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Directions to “ JESSICA RANAE MATHEWS ” Practice Location

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