MEDICARE: TROY DOUGLAS FAIRCHILD LPN

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	701719	CA

General Provider Information

NPI Number	:	1780156109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY DOUGLAS FAIRCHILD LPN

Provider Business Mailing Address
First Line	:	990 E CHIA RD
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4719
Country	:	US
Telephone Number	:	562-500-6131
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 E CHIA RD
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4719
Country	:	US
Telephone Number	:	562-500-6131
Fax Number	:

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

Provider Enumeration Date	:	12/24/2018
Last Update Date	:	12/24/2018

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