MEDICARE: MRS. KATE N/A VOLKOV I 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	164X00000X	Licensed Vocational Nurse	VN 175951	CA

General Provider Information

NPI Number	:	1871788901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATE N/A VOLKOV I LVN

Provider Business Mailing Address
First Line	:	3726 W NIELSEN AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-1106
Country	:	US
Telephone Number	:	559-441-1231
Fax Number	:	559-441-1231

Provider Business Practice Location Address
First Line	:	3726 W NIELSEN AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-1106
Country	:	US
Telephone Number	:	559-441-1231
Fax Number	:	559-441-1231

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

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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