Individual
JARED MICHAEL DE NICOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
4285 N RANCHO DR STE 130, LAS VEGAS, NV 89130-3455
(702) 385-5331
(702) 385-5678
Mailing address
10100 ELIDA RD, DELPHOS, OH 45833-9056
(419) 695-8010
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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