MEDICARE: DENISE AUDREY MORDUE-LAIN NP

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	NP6294	CA

General Provider Information

NPI Number	:	1730370172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE AUDREY MORDUE-LAIN NP

Provider Business Mailing Address
First Line	:	1919 VISTA DEL LAGO DR
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-9294
Country	:	US
Telephone Number	:	209-772-9538
Fax Number	:	209-772-0312

Provider Business Practice Location Address
First Line	:	1919 VISTA DEL LAGO DR
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-9294
Country	:	US
Telephone Number	:	209-772-9538
Fax Number	:	209-772-0312

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

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	04/19/2017

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