MEDICARE: LISA MARINA FLOWERS LICENSED VOCATIONAL

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	164W00000X	Licensed Practical Nurse	VN 203372	CA
2	164X00000X	Licensed Vocational Nurse	VN 203372	CA

General Provider Information

NPI Number	:	1720136997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARINA FLOWERS LICENSED VOCATIONAL

Provider Business Mailing Address
First Line	:	5769 W EL PASO AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-2286
Country	:	US
Telephone Number	:	559-895-2923
Fax Number	:

Provider Business Practice Location Address
First Line	:	5769 W EL PASO AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-2286
Country	:	US
Telephone Number	:	559-895-2923
Fax Number	:

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

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	08/06/2018

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