MEDICARE: CHRISTINE OLDENBOURG

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	519960	CA
2	364SF0001X	Family Health Clinical Nurse Specialist	519960	CA

General Provider Information

NPI Number	:	1437589058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE OLDENBOURG

Provider Business Mailing Address
First Line	:	1000 NEW HORIZONS WAY
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-9431
Country	:	US
Telephone Number	:	707-454-5192
Fax Number	:	707-454-5026

Provider Business Practice Location Address
First Line	:	1000 NEW HORIZONS WAY
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-9431
Country	:	US
Telephone Number	:	707-454-5192
Fax Number	:	707-454-5026

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

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	11/18/2013

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Directions to “ CHRISTINE OLDENBOURG ” Practice Location

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