MEDICARE: MRS. ERIN THERESA VELIKOFF FNP

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	163WP2201X	Ambulatory Care Registered Nurse	371046	CA
2	363LF0000X	Family Nurse Practitioner	4925	CA

General Provider Information

NPI Number	:	1306851787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN THERESA VELIKOFF FNP

Provider Business Mailing Address
First Line	:	3252 EL DORADO ROYALE DR
Second Line	:
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-8658
Country	:	US
Telephone Number	:	530-417-0197
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 J ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2605
Country	:	US
Telephone Number	:	916-278-6461
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	02/21/2012

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