MEDICARE: MERLE LAUREL

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	163W00000X	Registered Nurse	337501	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851707665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERLE LAUREL

Provider Business Mailing Address
First Line	:	3018 KING EST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1362
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3018 KING EST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95135-1362
Country	:	US
Telephone Number	:	408-921-9355
Fax Number	:	408-270-2094

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

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	07/02/2014

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Directions to “ MERLE LAUREL ” Practice Location

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