Jessica Dawn Minadeo
Individual provider Active NPI Registered Nurse · Peridot, AZ
NPI 1295445690 · NPPES record last updated Nov 28, 2022
Key facts
- NPI
- 1295445690
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- RN172680 (AZ)
- Practice address
- 103 Medicine Way Rd
Peridot, AZ 85542-5000 - Phone
- (928) 475-1540
- NPI assigned
- Nov 28, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN172680 | AZ | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN172680 | AZ | Yes |
Addresses
Primary practice location
103 Medicine Way Rd
Peridot, AZ 85542-5000
Mailing address
8643 S Thunderbird Dr
Safford, AZ 85546-7766
Phone (480) 266-9765
Other providers in Peridot, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.