MEDICARE: MRS. KATHLEEN E COLE 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
1	363LF0000X	Family Nurse Practitioner	NP 12534	CA

General Provider Information

NPI Number	:	1295879831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN E COLE NP

Provider Business Mailing Address
First Line	:	PO BOX 956
Second Line	:
City	:	RUNNING SPRINGS
State	:	CA
Zip	:	92382-0956
Country	:	US
Telephone Number	:	909-867-9258
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 UNIVERSITY PKWY
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-2318
Country	:	US
Telephone Number	:	909-537-5241
Fax Number	:

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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