MEDICARE: JANEEN MARIE FROST LVN

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	10001552	OR
2	164X00000X	Licensed Vocational Nurse	707282	CA

General Provider Information

NPI Number	:	1821783002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANEEN MARIE FROST LVN

Provider Business Mailing Address
First Line	:	81A GREGORY LN
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-5701
Country	:	US
Telephone Number	:	925-848-5916
Fax Number	:

Provider Business Practice Location Address
First Line	:	2995 YGNACIO VALLEY RD
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3535
Country	:	US
Telephone Number	:	925-848-5916
Fax Number	:

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

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	04/05/2023

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