MEDICARE: MISS SUHMER N FRYER NEMT , EDUCATOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	172V00000X	Community Health Worker	CA
2	174H00000X	Health Educator	CA
3	172A00000X	Driver

General Provider Information

NPI Number	:	1174086300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SUHMER N FRYER NEMT , EDUCATOR

Provider Business Mailing Address
First Line	:	PO BOX 294
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95617-0294
Country	:	US
Telephone Number	:	530-551-2182
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 BEECHCRAFT WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-4000
Country	:	US
Telephone Number	:	530-219-3070
Fax Number	:

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

Provider Enumeration Date	:	04/14/2019
Last Update Date	:	04/14/2019

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Directions to “ MISS SUHMER N FRYER NEMT , EDUCATOR” Practice Location

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