MEDICARE: BRYAN LAWRENCE COX L.V.N., R.N.

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	214668	CA
2	163W00000X	Registered Nurse	95110941	CA

General Provider Information

NPI Number	:	1598178154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN LAWRENCE COX L.V.N., R.N.

Provider Business Mailing Address
First Line	:	PO BOX 2692
Second Line	:
City	:	ORANGEVALE
State	:	CA
Zip	:	95662-7403
Country	:	US
Telephone Number	:	919-850-5686
Fax Number	:

Provider Business Practice Location Address
First Line	:	3331 S PORT DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-4553
Country	:	US
Telephone Number	:	919-850-5686
Fax Number	:

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

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	11/15/2016

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