MEDICARE: JOANNA TEDESCO

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	163WC0400X	Case Management Registered Nurse	RN64956	NV
2	163WH0200X	Home Health Registered Nurse	RN64956	NV
3	163WX0106X	Occupational Health Registered Nurse	RN64956	NV

General Provider Information

NPI Number	:	1922451038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA TEDESCO

Provider Business Mailing Address
First Line	:	6229 CLARICE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1301
Country	:	US
Telephone Number	:	702-954-1190
Fax Number	:	702-902-4815

Provider Business Practice Location Address
First Line	:	6229 CLARICE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1301
Country	:	US
Telephone Number	:	702-954-1190
Fax Number	:	702-902-4815

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

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	07/14/2016

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Directions to “ JOANNA TEDESCO ” Practice Location

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