MEDICARE: KATHLEEN BATTERSBY CPNP

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	363LP0200X	Pediatric Nurse Practitioner	283243	CA

General Provider Information

NPI Number	:	1720121239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN BATTERSBY CPNP

Provider Business Mailing Address
First Line	:	4132 MOORE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5724
Country	:	US
Telephone Number	:	310-821-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 E MARENGO ST
Second Line	:	ROOM 1G1
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1365
Country	:	US
Telephone Number	:	323-226-3813
Fax Number	:	323-226-5049

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	03/25/2010

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