MEDICARE: DEBORAH JEAN COMSTOCK 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	VN102766	CA

General Provider Information

NPI Number	:	1659431419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH JEAN COMSTOCK LVN

Provider Business Mailing Address
First Line	:	2178 JOHNSON AVE
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-4535
Country	:	US
Telephone Number	:	805-237-3170
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 VINE ST
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-2559
Country	:	US
Telephone Number	:	805-237-3170
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	10/09/2008

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