MEDICARE: JANIS CALDWELL POLOS

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	14648	CA

General Provider Information

NPI Number	:	1366621369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIS CALDWELL POLOS

Provider Business Mailing Address
First Line	:	2505 LUCAS ST
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501-3340
Country	:	US
Telephone Number	:	707-445-3065
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 LUCAS ST
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95501-3340
Country	:	US
Telephone Number	:	707-445-3063
Fax Number	:

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

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/26/2007

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Directions to “ JANIS CALDWELL POLOS ” Practice Location

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