Provider Demographics
NPI:1730878901
Name:AMICO, JEAN ANN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:AMICO
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 1:2925 E DEVLIN AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-2079
Mailing Address - Country:US
Mailing Address - Phone:928-530-4504
Mailing Address - Fax:
Practice Address - Street 1:2925 E DEVLIN AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-2079
Practice Address - Country:US
Practice Address - Phone:928-530-4504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant