MEDICARE: BETH N CHOPRA RN, MSN, CPNP

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	363LP0200X	Pediatric Nurse Practitioner	21177	CA

General Provider Information

NPI Number	:	1104182047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH N CHOPRA RN, MSN, CPNP

Provider Business Mailing Address
First Line	:	1381 WOODLAND AVE
Second Line	:
City	:	MENLO PARK
State	:	CA
Zip	:	94025-2849
Country	:	US
Telephone Number	:	415-572-5571
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 EUREKA SQ
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-2652
Country	:	US
Telephone Number	:	650-359-1675
Fax Number	:

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

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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