MEDICARE: JENNY ROBELLI CNA/RS

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1457545931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY ROBELLI CNA/RS

Provider Business Mailing Address
First Line	:	3125 N BUFFALO DR
Second Line	:	UNIT 2134
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7837
Country	:	US
Telephone Number	:	702-372-7624
Fax Number	:

Provider Business Practice Location Address
First Line	:	3125 N BUFFALO DR
Second Line	:	UNIT 2134
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7837
Country	:	US
Telephone Number	:	702-372-7624
Fax Number	:

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/28/2007

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