MEDICARE: DR. ROBERTA ANNE BAVIN CPNP

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	363LP0200X	Pediatric Nurse Practitioner	RN262580	CA
2	363LP0200X	Pediatric Nurse Practitioner	NPF 5669	CA

General Provider Information

NPI Number	:	1326047499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTA ANNE BAVIN CPNP

Provider Business Mailing Address
First Line	:	510 BARSTOW AVE
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93612-2228
Country	:	US
Telephone Number	:	559-327-7976
Fax Number	:	559-327-7974

Provider Business Practice Location Address
First Line	:	510 BARSTOW AVE
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93612-2228
Country	:	US
Telephone Number	:	559-327-7976
Fax Number	:	559-327-7974

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	08/11/2014

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