MEDICARE: AMY BARTLETT

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	163WP0200X	Pediatric Registered Nurse	720079	CA

General Provider Information

NPI Number	:	1598140428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BARTLETT

Provider Business Mailing Address
First Line	:	2914 RADNOR AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1318
Country	:	US
Telephone Number	:	562-305-5275
Fax Number	:

Provider Business Practice Location Address
First Line	:	2914 RADNOR AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-1318
Country	:	US
Telephone Number	:	562-305-5275
Fax Number	:

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

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	07/21/2015

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Directions to “ AMY BARTLETT ” Practice Location

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