MEDICARE: MELANIE ANN YURKOVICH F.N.P.

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	363LF0000X	Family Nurse Practitioner	484876	CA

General Provider Information

NPI Number	:	1962772335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE ANN YURKOVICH F.N.P.

Provider Business Mailing Address
First Line	:	768 MOUNTAIN RANCH RD
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249-9707
Country	:	US
Telephone Number	:	209-754-3521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 VISTA DEL LAGO
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	:	01/03/2012
Last Update Date	:	03/13/2014

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