MEDICARE: JENNY B NATION FNP-C

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	363LF0000X	Family Nurse Practitioner	CNP-62327	NM
2	207Q00000X	Family Medicine Physician	62327	NM

General Provider Information

NPI Number	:	1780270280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY B NATION FNP-C

Provider Business Mailing Address
First Line	:	611 NATIONAL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4243
Country	:	US
Telephone Number	:	505-426-0070
Fax Number	:	505-426-0702

Provider Business Practice Location Address
First Line	:	611 NATIONAL AVE
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4243
Country	:	US
Telephone Number	:	505-426-0700
Fax Number	:	505-426-0702

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

Provider Enumeration Date	:	12/18/2020
Last Update Date	:	03/04/2024

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