MEDICARE: SHYLANDER ALLEN LVN

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	VN232514	CA
2	164X00000X	Licensed Vocational Nurse	232514	CA

General Provider Information

NPI Number	:	1518370303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYLANDER ALLEN LVN

Provider Business Mailing Address
First Line	:	56590 EL DORADO DR
Second Line	:
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92284-4233
Country	:	US
Telephone Number	:	562-688-7228
Fax Number	:

Provider Business Practice Location Address
First Line	:	56590 EL DORADO DR
Second Line	:
City	:	YUCCA VALLEY
State	:	CA
Zip	:	92284-4233
Country	:	US
Telephone Number	:	562-688-7228
Fax Number	:

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	07/30/2021

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