MEDICARE: KATHRYN PELOSI

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	124Q00000X	Dental Hygienist	DH00002664	WA

General Provider Information

NPI Number	:	1710309729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN PELOSI

Provider Business Mailing Address
First Line	:	130 S INDIANA AVE
Second Line	:
City	:	ENGLEWOOD
State	:	FL
Zip	:	34223-3301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 S INDIANA AVE
Second Line	:
City	:	ENGLEWOOD
State	:	FL
Zip	:	34223-3301
Country	:	US
Telephone Number	:	941-475-2442
Fax Number	:

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

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	01/09/2014

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