MEDICARE: MARY KAY SINGELMAN

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	164X00000X	Licensed Vocational Nurse	VN 229314	CA

General Provider Information

NPI Number	:	1366675456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KAY SINGELMAN

Provider Business Mailing Address
First Line	:	5058 ALTA DR
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-2921
Country	:	US
Telephone Number	:	909-471-1540
Fax Number	:

Provider Business Practice Location Address
First Line	:	5058 ALTA DR
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92407-2921
Country	:	US
Telephone Number	:	909-471-1540
Fax Number	:

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

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	08/24/2009

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Directions to “ MARY KAY SINGELMAN ” Practice Location

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