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NPI Code Detail

MEDICARE: JAMES FREDERICK RENDO RN

MEDICARE:   JAMES FREDERICK RENDO  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
1163WC0400XCase Management Registered Nurse7946683-3102UT

General Provider Information

NPI Number : 1689934572
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES FREDERICK RENDO RN
Provider Business Mailing Address
First Line : 2750 S 5600 W
Second Line : SUITE B
City : WEST VALLEY CITY
State : UT
Zip : 84120-1249
Country : US
Telephone Number : 801-582-1565
Fax Number : 801-584-1276
Provider Business Practice Location Address
First Line : 2750 S 5600 W
Second Line : SUITE B
City : WEST VALLEY CITY
State : UT
Zip : 84120-1249
Country : US
Telephone Number : 801-582-1565
Fax Number : 801-584-1276
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2012
Last Update Date : 05/24/2012

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