MEDICARE: MARIE JEUNIDE FAVERDIEU CNA

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	3747P1801X	Personal Care Attendant		ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740889435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE JEUNIDE FAVERDIEU CNA

Provider Business Mailing Address
First Line	:	3562 8TH ST E
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-5422
Country	:	US
Telephone Number	:	701-541-7351
Fax Number	:	701-532-2104

Provider Business Practice Location Address
First Line	:	3562 8TH ST E
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-5422
Country	:	US
Telephone Number	:	701-541-7351
Fax Number	:	701-532-2104

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

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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