MEDICARE: VICKI LANDRY R.N.

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	163W00000X	Registered Nurse	256987	CA

General Provider Information

NPI Number	:	1407203698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI LANDRY R.N.

Provider Business Mailing Address
First Line	:	3350 E 7TH ST
Second Line	:	733
City	:	LONG BEACH
State	:	CA
Zip	:	90804-5003
Country	:	US
Telephone Number	:	661-219-5007
Fax Number	:

Provider Business Practice Location Address
First Line	:	3350 E 7TH ST
Second Line	:	733
City	:	LONG BEACH
State	:	CA
Zip	:	90804-5003
Country	:	US
Telephone Number	:	661-219-5007
Fax Number	:

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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Directions to “ VICKI LANDRY R.N.” Practice Location

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