MEDICARE: NE'ONEASHIA N. FORD 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
1	163WG0000X	General Practice Registered Nurse	777592	TX

General Provider Information

NPI Number	:	1497235543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NE'ONEASHIA N. FORD RN

Provider Business Mailing Address
First Line	:	3206 CRIPPLE CREEK ST APT 12E
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2474
Country	:	US
Telephone Number	:	210-388-5212
Fax Number	:

Provider Business Practice Location Address
First Line	:	3206 CRIPPLE CREEK ST APT 12E
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2474
Country	:	US
Telephone Number	:	210-388-5212
Fax Number	:

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

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	08/17/2018

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