MEDICARE: MRS. CHERI MARLENE IMOE 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	VN43117	CA

General Provider Information

NPI Number	:	1659688836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERI MARLENE IMOE LVN

Provider Business Mailing Address
First Line	:	519 W TAYLOR ST SPC 364A
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-1029
Country	:	US
Telephone Number	:	805-361-0288
Fax Number	:

Provider Business Practice Location Address
First Line	:	519 W TAYLOR ST SPC 364A
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-1029
Country	:	US
Telephone Number	:	805-361-0288
Fax Number	:

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

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/08/2010

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