MEDICARE: MANDY JO VENABLE RN

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	RN00149963	WA
2	163W00000X	Registered Nurse	22359	WY

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

General Provider Information

NPI Number	:	1942413117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY JO VENABLE RN

Provider Business Mailing Address
First Line	:	3620 49TH AVE SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98512-6604
Country	:	US
Telephone Number	:	307-254-4874
Fax Number	:

Provider Business Practice Location Address
First Line	:	1151 LANE 6
Second Line	:
City	:	POWELL
State	:	WY
Zip	:	82435-9717
Country	:	US
Telephone Number	:	307-202-1137
Fax Number	:

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	03/13/2026

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