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NPI Code Detail

MEDICARE: MRS. STACY ELIZABETH BJERKE

MEDICARE: MRS. STACY ELIZABETH BJERKE
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1528199924
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACY ELIZABETH BJERKE
Provider Business Mailing Address
First Line : 11639 MIRO CIR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92131-3320
Country : US
Telephone Number : 858-689-9663
Fax Number : 858-505-6301
Provider Business Practice Location Address
First Line : 9335 HAZARD WAY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1222
Country : US
Telephone Number : 858-495-5442
Fax Number : 858-505-6301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/08/2007

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