MEDICARE: MRS. QUINCY JEAN BATES CPM, LM

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	176B00000X	Midwife	282	CA

General Provider Information

NPI Number	:	1700194230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. QUINCY JEAN BATES CPM, LM

Provider Business Mailing Address
First Line	:	7849 ELK TRL
Second Line	:
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92284-3317
Country	:	US
Telephone Number	:	760-228-1011
Fax Number	:	760-228-1011

Provider Business Practice Location Address
First Line	:	7849 ELK TRL
Second Line	:
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92284-3317
Country	:	US
Telephone Number	:	760-228-1011
Fax Number	:	760-228-1011

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

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	11/02/2010

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