MEDICARE: JESSICA KERWIN

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	163W00000X	Registered Nurse	191606-30	WI

General Provider Information

NPI Number	:	1669883328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KERWIN

Provider Business Mailing Address
First Line	:	3989 N RIVER RD
Second Line	:
City	:	OCONTO
State	:	WI
Zip	:	54153-9226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3989 N RIVER RD
Second Line	:
City	:	OCONTO
State	:	WI
Zip	:	54153-9226
Country	:	US
Telephone Number	:	906-290-3933
Fax Number	:

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

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	05/15/2014

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