MEDICARE: MR. GLENN ARTHUR FORAN RN

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	163W00000X	Registered Nurse	401099	CA

General Provider Information

NPI Number	:	1851545826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GLENN ARTHUR FORAN RN

Provider Business Mailing Address
First Line	:	915 WALNUT AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-5033
Country	:	US
Telephone Number	:	562-607-1614
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 WALNUT AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-5033
Country	:	US
Telephone Number	:	562-607-1614
Fax Number	:

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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