MEDICARE: MRS. DARLENE MERCHELLE WELDONQUIVEORS 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	VN122809	CA

General Provider Information

NPI Number	:	1558899922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARLENE MERCHELLE WELDONQUIVEORS LVN

Provider Business Mailing Address
First Line	:	2531 MAINE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2824
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 E MARSHALL PL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3743
Country	:	US
Telephone Number	:	562-270-6344
Fax Number	:

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

Provider Enumeration Date	:	05/30/2017
Last Update Date	:	03/17/2018

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