MEDICARE: MRS. VALERIE EVADNE TAYLOR LVN

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	164X00000X	Licensed Vocational Nurse	VN215688	CA

General Provider Information

NPI Number	:	1053504647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VALERIE EVADNE TAYLOR LVN

Provider Business Mailing Address
First Line	:	4611 W MARTIN LUTHER KING JR BLVD
Second Line	:	APARTMENT 197
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-5556
Country	:	US
Telephone Number	:	323-296-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	4611 W MARTIN LUTHER KING JR BLVD
Second Line	:	APARTMENT 197
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-5556
Country	:	US
Telephone Number	:	323-296-0249
Fax Number	:

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

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/27/2007

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