MEDICARE: JANA D BITTICK RNFA

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	163WR0006X	Registered Nurse First Assistant	524764	TX

General Provider Information

NPI Number	:	1821244195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA D BITTICK RNFA

Provider Business Mailing Address
First Line	:	1286 COUNTY ROAD 2788
Second Line	:
City	:	ALVORD
State	:	TX
Zip	:	76225-3355
Country	:	US
Telephone Number	:	817-456-7754
Fax Number	:

Provider Business Practice Location Address
First Line	:	1286 COUNTY ROAD 2788
Second Line	:
City	:	ALVORD
State	:	TX
Zip	:	76225-3355
Country	:	US
Telephone Number	:	817-456-7754
Fax Number	:

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

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/18/2008

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