MEDICARE: MS. RHODA LYNN JUZANG

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	R870754	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	358702YUPL	OTHER	MS	MS MEDICARE
5	P01861916	OTHER	MS	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4864514	OTHER	MS	MAILHANDLERS
4	12671825	OTHER	MS	CAQH
6	5198833	OTHER	MS	AETNA

General Provider Information

NPI Number	:	1932209715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RHODA LYNN JUZANG

Provider Business Mailing Address
First Line	:	PO BOX 4594
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39535-4594
Country	:	US
Telephone Number	:	228-273-4096
Fax Number	:	228-594-1765

Provider Business Practice Location Address
First Line	:	180 DEBUYS RD
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-4402
Country	:	US
Telephone Number	:	228-273-4096
Fax Number	:	228-594-1765

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	01/06/2020

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