MEDICARE: JACOB VENSTAD RN, BSN

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	163W00000X	Registered Nurse	829432	TX

General Provider Information

NPI Number	:	1932929890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB VENSTAD RN, BSN

Provider Business Mailing Address
First Line	:	7717 GLENWOOD SPRINGS LN
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-2694
Country	:	US
Telephone Number	:	512-568-0277
Fax Number	:

Provider Business Practice Location Address
First Line	:	7717 GLENWOOD SPRINGS LN
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75070-2694
Country	:	US
Telephone Number	:	512-568-0277
Fax Number	:

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

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/15/2024

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