MEDICARE: MRS. CHERI RENA COLLETT 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	492581	CA

General Provider Information

NPI Number	:	1073697470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERI RENA COLLETT RN

Provider Business Mailing Address
First Line	:	1691 THE ALAMEDA
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2203
Country	:	US
Telephone Number	:	408-287-7532
Fax Number	:	408-287-0405

Provider Business Practice Location Address
First Line	:	3166 COLLINS DR
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-3132
Country	:	US
Telephone Number	:	209-723-7753
Fax Number	:	209-723-0295

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/26/2007

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