MEDICARE: ALLYSE ANNETTE VANEVERY CASE MANAGER II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	171M00000X	Case Manager/Care Coordinator
3	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1417462300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSE ANNETTE VANEVERY CASE MANAGER II

Provider Business Mailing Address
First Line	:	201 D ST STE R
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-5952
Country	:	US
Telephone Number	:	530-441-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 D ST STE R
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-5952
Country	:	US
Telephone Number	:	530-441-2400
Fax Number	:

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

Provider Enumeration Date	:	12/13/2017
Last Update Date	:	01/23/2024

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