Provider Demographics
NPI:1952602757
Name:NARCISO, JENNASEN
Entity Type:Individual
Prefix:
First Name:JENNASEN
Middle Name:
Last Name:NARCISO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6732 DIVERS LOONS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2691
Mailing Address - Country:US
Mailing Address - Phone:702-379-7571
Mailing Address - Fax:
Practice Address - Street 1:6732 DIVERS LOONS ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2691
Practice Address - Country:US
Practice Address - Phone:702-379-7571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractor