MEDICARE: ANGELINE BAZELAIS

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	376K00000X	Nurse's Aide	CNA 42848	FL

General Provider Information

NPI Number	:	1699988394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELINE BAZELAIS

Provider Business Mailing Address
First Line	:	802 HOLLY AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-6209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 HOLLY AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-6209
Country	:	US
Telephone Number	:	772-460-4791
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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