MEDICARE: CRISTINA S CENTURION NP-C

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	363LF0000X	Family Nurse Practitioner	16315	CA
2	363LF0000X	Family Nurse Practitioner	F335330-1	NY
3	363LF0000X	Family Nurse Practitioner	26NJ00100900	NJ

General Provider Information

NPI Number	:	1710053095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA S CENTURION NP-C

Provider Business Mailing Address
First Line	:	106 LYNCH CREEK WAY
Second Line	:	SUITE 8
City	:	PETALUMA
State	:	CA
Zip	:	94954-2356
Country	:	US
Telephone Number	:	707-763-6816
Fax Number	:	707-763-1730

Provider Business Practice Location Address
First Line	:	106 LYNCH CREEK WAY
Second Line	:	SUITE 8
City	:	PETALUMA
State	:	CA
Zip	:	94954-2356
Country	:	US
Telephone Number	:	707-763-6816
Fax Number	:	707-763-1730

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	04/29/2013

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