MEDICARE: MISS DOROTHEA ARNELL SLEDGE BSN

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	163W00000X	Registered Nurse	490502	CA

General Provider Information

NPI Number	:	1649250226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DOROTHEA ARNELL SLEDGE BSN

Provider Business Mailing Address
First Line	:	1632 GOLD RUN RD
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-1595
Country	:	US
Telephone Number	:	619-754-6852
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 ROSECRANS ST
Second Line	:	BUILDING 500
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-4408
Country	:	US
Telephone Number	:	619-553-8573
Fax Number	:	619-553-8310

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/08/2007

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