MEDICARE: REJUVE AESTHETIC & WELLNESS CENTER INC

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

General Provider Information

NPI Number	:	1780290759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REJUVE AESTHETIC & WELLNESS CENTER INC

Provider Business Mailing Address
First Line	:	8202 TEAKWOOD FOREST DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-4538
Country	:	US
Telephone Number	:	281-658-1045
Fax Number	:	281-658-1045

Provider Business Practice Location Address
First Line	:	2222 BISSONNET ST STE 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-2364
Country	:	US
Telephone Number	:	281-658-1045
Fax Number	:	281-569-4186

Authorized Official
Title or Position	:	CO-OWNER
Name	:	JAMIE L FERRARO
Credential	:	APRN, FNP-C
Telephone Number	:	281-658-1045

Provider Enumeration Date	:	09/16/2020
Last Update Date	:	09/16/2020

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