Provider Demographics
NPI:1720801616
Name:RESTREPO, JENNIFER EMILY
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EMILY
Last Name:RESTREPO
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 1:4213 ENGLISH WALNUT CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-4121
Mailing Address - Country:US
Mailing Address - Phone:917-599-3504
Mailing Address - Fax:
Practice Address - Street 1:4213 ENGLISH WALNUT CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-4121
Practice Address - Country:US
Practice Address - Phone:917-599-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant