MEDICARE: MRS. MARY KATHLEEN RYKEN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	271315	CA

General Provider Information

NPI Number	:	1023581766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY KATHLEEN RYKEN RN

Provider Business Mailing Address
First Line	:	2269 VEGAS AVE
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-6358
Country	:	US
Telephone Number	:	510-693-4586
Fax Number	:

Provider Business Practice Location Address
First Line	:	2269 VEGAS AVE
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-6358
Country	:	US
Telephone Number	:	510-693-4586
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	01/04/2019

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