MEDICARE: JESSIE A ANDRADE LVN

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	164X00000X	Licensed Vocational Nurse	VN23796	CA

General Provider Information

NPI Number	:	1568581593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE A ANDRADE LVN

Provider Business Mailing Address
First Line	:	YCADMH 137 N.COTTONWOOD
Second Line	:	SUITE 1520
City	:	WOODLAND
State	:	CA
Zip	:	95695
Country	:	US
Telephone Number	:	530-666-8630
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 NO. COTTONWOOD ST.
Second Line	:	SUITE 1520
City	:	WOODLAND
State	:	CA
Zip	:	95695
Country	:	US
Telephone Number	:	530-666-8630
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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