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NPI Code Detail

MEDICARE: JAEDAH B ANDRUS

MEDICARE: JAEDAH B ANDRUS
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
1372500000XChore Provider
23747A0650XAttendant Care Provider
3376J00000XHomemaker
43747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1750844148
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAEDAH B ANDRUS
Provider Business Mailing Address
First Line : 1750 RUSSELL WAY APT J
Second Line :
City : CARSON CITY
State : NV
Zip : 89706-2776
Country : US
Telephone Number : 775-671-5791
Fax Number :
Provider Business Practice Location Address
First Line : 343 FAIRVIEW DR STE 101
Second Line :
City : CARSON CITY
State : NV
Zip : 89701-5389
Country : US
Telephone Number : 775-887-5683
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2019
Last Update Date : 04/11/2019

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Directions to “ JAEDAH B ANDRUS ” Practice Location

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