MEDICARE: JEWETT JACQUES HARRINGTON CNM

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	367A00000X	Advanced Practice Midwife	NMW1027	CA

General Provider Information

NPI Number	:	1790952943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEWETT JACQUES HARRINGTON CNM

Provider Business Mailing Address
First Line	:	2005 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3503
Country	:	US
Telephone Number	:	213-484-4444
Fax Number	:	213-483-1902

Provider Business Practice Location Address
First Line	:	2005 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3503
Country	:	US
Telephone Number	:	213-484-4444
Fax Number	:	213-483-1902

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	12/03/2021

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