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NPI Code Detail

MEDICARE: LAURIE ELLISON LVN

MEDICARE: LAURIE ELLISON LVN
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
1164X00000XLicensed Vocational NurseVN 208107CA

General Provider Information

NPI Number : 1336355536
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE ELLISON LVN
Provider Business Mailing Address
First Line : 485 RICARDO DR
Second Line :
City : AROMAS
State : CA
Zip : 95004-9532
Country : US
Telephone Number : 831-726-0485
Fax Number :
Provider Business Practice Location Address
First Line : 1131 SAN FELIPE RD
Second Line :
City : HOLLISTER
State : CA
Zip : 95023-2800
Country : US
Telephone Number : 831-636-4020
Fax Number : 831-636-4025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 07/08/2007

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Directions to “ LAURIE ELLISON LVN” Practice Location

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