MEDICARE: MS. CAROLYNN RUTH BELKE

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	172A00000X	Driver	B8011905	CA

General Provider Information

NPI Number	:	1295473130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYNN RUTH BELKE

Provider Business Mailing Address
First Line	:	1236 DE MOLL DR
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96002-3220
Country	:	US
Telephone Number	:	530-921-0018
Fax Number	:

Provider Business Practice Location Address
First Line	:	1236 DE MOLL DR
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96002-3220
Country	:	US
Telephone Number	:	530-921-0018
Fax Number	:	530-319-3799

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

Provider Enumeration Date	:	05/20/2022
Last Update Date	:	05/20/2022

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