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NPI Code Detail

MEDICARE: MRS. LUCILLE A CAPO ROME NP

MEDICARE: MRS. LUCILLE A CAPO ROME 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
1163WP0809XAdult Psychiatric/Mental Health Registered Nurse497364CA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner6863CA

General Provider Information

NPI Number : 1033262654
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LUCILLE A CAPO ROME NP
Provider Business Mailing Address
First Line : 2225 CHALLENGER WAY
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-5441
Country : US
Telephone Number : 707-565-6625
Fax Number :
Provider Business Practice Location Address
First Line : 2225 CHALLENGER WAY
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-5441
Country : US
Telephone Number : 707-565-6625
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 04/11/2017

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