MEDICARE: JEANELL GRAVES GUENTHER FNP

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	17052	CA

General Provider Information

NPI Number	:	1821153420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANELL GRAVES GUENTHER FNP

Provider Business Mailing Address
First Line	:	8400 SUN HARBOR DR
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-4901
Country	:	US
Telephone Number	:	661-587-1524
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 SUN HARBOR DR
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-4901
Country	:	US
Telephone Number	:	661-587-1524
Fax Number	:

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

Provider Enumeration Date	:	12/25/2006
Last Update Date	:	07/08/2007

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